2013 Australian Conference on Science and Mathematics (19th UniServe Science Conference) Registration

Please enter the following details about yourself:

Title *
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First Name *
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Last Name *
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Department, Degree or Discipline for Name Tag *
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Preferred Name for Name Tag *
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University * Sydney
Other university

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Telephone *
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Dietary requirements
Special requirements (Access etc)
First time attendee? * Yes      No
I am a full-time student * No       Yes