IMGC2017

Tenth International Mining Geology Conference 2017 AIG Member Registration Form

Please enter your details below.  
Details below should be of the delegate attending the conference. If you are completing this online form on behalf of someone please ensure their email is recorded to ensure they receive all the conference information including the conference program, leading up to event.
AIG member no.
Title
First name
Last name
Gender
Organisation
Position
Address line 1
Address line 2
City
State
Postcode
Country
Mobile phone
Work phone
Email address
Marketing
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How did you hear about this event? AusIMM events promo email
  Past conference participant
  AusIMM events newsletter
  The AusIMM Bulletin
  Individual contact
  AusIMM branch contact
  Kindred body or industry association
  Online journal or magazine
  Other

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Please indicate if you do NOT wish to appear on the list of participants provided to all delegates at the event containing name, position, company and email address.
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All enquiries:
Suzie Chan, Senior Coordinator, Events 
The AusIMM PO Box 660, Carlton South, Vic 3053 Australia.
Telephone: +61 3 9658 6126
 | Email: schan@ausimm.com.au                                                    Website: www.ausimm.com.au