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\begin{document}

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{\bf {\large Sixteenth Australasian Workshop on}}

{\bf {\large Combinatorial Algorithms,  September 18-21, 2005}}\\

University of Ballarat, Australia 

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{\bf AWOCA 2005 REGISTRATION FORM/TAX INVOICE}

{\bf University of Ballarat \ \ \ \ A.B.N. ~ 51 818 692 256} 
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Name:  &  \\
Student: &   YES~/~NO ~~ (If yes, attach certifying letter) \\
Affiliation \& & \hspace{-10pt} Address:  \\
       &  \\  % line 2 of address
       &  \\  % line 3 of address
       &  \\  % line 4 of address
Phone: &  \\
Fax:   &  \\
Email: &  \\
       &  \\
Special Diet & \hspace{-10pt} (if any):  \\
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Registration fee ({\bf see website for fee details}) &  & AU\$  \\

Extra conference dinners (AU\$50 per head) &  & AU\$  \\

Total amount enclosed: &  & AU\$  \\
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\noindent 
If you are paying by credit card, please fill in the following: \\

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Name on the card:    &   \\
Type of credit card: &  MASTERCARD~/~BANKCARD~/~VISA~/AMEX  \\
Credit card number:  &   \\
Card Expiry Date:    &   \\
Signature and Date:  &   \\
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\noindent This document will become a tax invoice for Australian G.S.T.
(Goods and Services Tax) upon payment.  ~Confirmation will be e-mailed
upon receipt of registration fee. ~All fees above include G.S.T. ~Please
retain a copy for your records. 

\noindent If paying by credit-card, you can fax this form to
+61-3-5327-9376.  ~If
paying by cheque or money-order ({\bf payable to The University of
Ballarat}), please mail this form to us along with
your payment, ~ All payment should be in {\bf Australian dollars}. 
Please see AWOCA 2005 website for more information. 

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