INTERNET SOCIETY OF AUSTRALIA             Tax Invoice     ABN 36 076 406 801     

I wish to register for the ISOC-AU Fred Baker event in:

  [  ] SYDNEY                                  [  ] MELBOURNE
  Date: 17 October 2001                        Date: 18 October 2001
  Time: 7:00pm for 7:30pm                      Time: 7:00pm for 7:30pm
  Telstra Theatrette                           Investment Centre
  Ground Floor, 233 Castlereagh St,            Level 46, 55 Collins Street,
  Sydney                                       Melbourne


Title:_______ First name:__________________ Last name:_________________________

Organisation:__________________________________________________________________

Address:_______________________________________________________________________

State:_____________  Postcode:_______________  Country: _______________________

Phone:________________________________  Fax:___________________________________

Email address:_________________________________________________________________


[ ]Au$17.50 ISOC-AU Member                              Member no.___________ 

[ ]Au$22.00 Supporting Organisation                     Member no.___________ 
   [ ] ATUG    [ ] AUUG    [ ] SAGE-AU    [ ] ACS    [ ] IEEE
   [ ] ACTPCUsers          [ ] SydPCUsers

[ ]Au$88.00 Non-Member (discounts available for 10 or more registrations)

[ ]Au$0.00  Complementary ISOC-AU Sponsor 
   [ ] Telstra     [ ] Cisco           [ ] ANU       - limit of 3 registrations
   [ ] connect     [ ] Perth Internet  [ ] Internode - limit of 2 registrations
   [ ] TransACT                                      - limit of 1 registration

Payment by: [ ]Cheque          [ ]Mastercard       [ ]Visa       [ ]Bankcard

Card Number:___________________________________________________________________

Expiry Date:____________________  Name on Card:________________________________

Signed: __________________________________________ Date________________________

FAX FORM and CARD DETAILS to: (02) 6262 9938
or POST FORM and CHEQUE to:   The Internet Society of Australia 
                              PO Box 152, Civic Square ACT 2608 Australia

RSVP BY: 12 October 2001 to ed@isoc-au.org.au

[ ]  Please send me information about ISOC-AU Membership.
[ ]  Please send me information about ISOC-AU Sponsorship.