DRAFT Registration Form 2020 This form is for testing only 11 March 2020 Online registration form 2020 DRAFT V1.4 11 March 2020 An early bird discount of 10% will be applied to all registrations fully paid on or before 30 June 2020. This discount does not apply to the Social Package Selection of individual workshops will be done via our app which will be accessible early in September 2020.Please ensure you have explored this website for all details on the conference program before commencing this form. This form uses conditional logic to hide and reveal options depending on your choices. Therefore, reading the program, choosing which days you would like to attend before commencing this form is highly recommended. Link to program??This form includes online payment. A credit card will be required to complete the registration. If you have any questions please contact us at: conference@historyteacher.org.au TitleMrMrsMsDrProfName* First Last Email* School name*School Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Best contact phone number*Dietary requirementsWhat is your main area of interest?PrimaryMiddle YearsSeniorConference Attendance FeesPlease select the appropriate category. If you are not attending the full conference program, select 'I cannot attend all 3 days' for further options. *All fees include GSTMember means a member of a History Teachers’ Association affiliated with the History Teachers’ Association of Australia which are identified here. Verification may be requested. Full-time Student means somebody enrolled as a full time student in a recognised Australian educational institution. Verification may be requested.Workshop Presenters only pay for the days they are NOT presentingConference fee – three days*Non-member $535.50Member $405Full-time Student $157.50I cannot attend all three days show me my registration optionsChoosing less than 3 days PLEASE ensure you select the day(s) you will be attending. Payment categories for each day will be revealed after you have chosen your days. Choose the day(s) you would like to attend To choose multiple days hold down the 'Control' key while clicking the days.For the purposes of testing the form please choose Day 1 Choose the day(s) you would like to attendDay 1: September 30thDay 2: October 1stDay 3: October 2ndI am only attending a social eventDay 1: 30th September*Non-Member $211.50Member $175.50Full-time Student $67.50Presenter - day presentingPresenter - other days $157.50Day 2: 1st October*Non-Member $211.50Member $175.50Full-time Student $67.50Presenter - day presentingPresenter - other days $157.50Day 3: 2nd October*Non-Member $211.50Member $175.50Full-time Student $67.50Presenter - day presentingPresenter - other days $157.50NOTE FOR DRAFT FORM ONLY Day 2 and 3 will be presented similar to above depending on conditional logicSocial ProgramNetwork with your colleagues.Social events*Social Package - Cost of $95 per registered delegateAttendingNot attendingFeesAll Conference Registration Fees and Additional Ticket rates are quoted in Australian Dollars and are inclusive of 10% Goods and Services Tax (GST).SummaryTotal $ 0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name