Registration: Virtual Pump Workshop

Registration Form

Title:
First Name: * 
Last Name: * 
City: * 
State / Territory:
Postcode / ZIP:
Country:
Business Phone:
Email: * 
Confirm Email: * 
Appita Member Number (If Applicable):

Registration Options
Registration Rates:
Appita Members - Aust $330  
Non Members - Aust $440  
Appita Members - OS $300  
Non Members - OS $400  

If Paying with American Express please tick box below
(Only tick the box if you are paying with an Amex card):
I am paying with American Express and understand I will be charged a 1.5% surcharge.
Enter the Security Code: * 
I agree to the terms and conditions: * 
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