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AWC2012 Countdown
123 Days

Please use the form below to register to attend the 2012 Australian Wiccan Conference. An * denotes manditory fields or sections.

I am a presenter and have been given a presenters registration code

Please enter your presenter code here


Guest #1 Main Contact Registration Type *
Membership type and details	Member number only applicable if you are a PAN / PA or Combined Covens Member, otherwise select none
Registration Type

Guest #1 Main Contact Personal Details *
First Name *
Last Name *
Street address *
Suburb *
Postcode *
State *
Phone
Mobile
Date of birth *
Email address *
Accommodation Type *

Guest #2 Registration Type
Member number	Member number only applicable if you are a PAN / PA or Combined Covens Member, otherwise select none
Registration Type

Guest #2 Personal Details
First Name *
Last Name *
Date of birth *
Accommodation Type

Guest #3 Registration Type
Member number	Member number only applicable if you are a PAN / PA or Combined Covens Member, otherwise select none
Registration Type

Guest #3 Personal Details
First Name *
Last Name *
Date of birth *
Accommodation Type

Guest #4 Registration Type
Member number	Member number only applicable if you are a PAN / PA or Combined Covens Member, otherwise select none
Registration Type

Guest #4 Personal Details
First Name *
Last Name *
Date of birth *
Accommodation Type

Prefered Contact Method
How would you like to recieve you Gathering information?	(PAN's privacy policy is available on our website or can be mailed to you by request)

Sharing a Lodge
If you have selected lodge as your accomodation type, Is there anyone not listed in this form that you would like to share a lodge with?


By completing my registration to attend the Australian Wiccan Conference 2012, I assert the following *
I understand that by registering for the Australian Wiccan Conference 2012. I agree to abide by the rules and guidlines of the event Click Here for the Rules and Guidlines. The person completing this registration is over the age of 18.
I have read, understood and agree to the statements listed above

Payment Details *
I have sent $ as a

When you press the "Submit" button below you will be taken to the secure PayPal website to pay for your registration. Please ensure you continue through to the checkout.

YOU MUST HAVE A PAYPAL ACCOUNT TO PROCEED.

When you press the "Submit" button below you will be taken to another page on the PAN website to select your installment plan and then selecting pay via the PayPal website to pay for your registration. Please ensure you continue through to the checkout.

Your Payment Plan will consist of an inital deposit of $50 and the remainder of the registration fee will be split into three (3) equal payments that will be taken out of your PayPal Account on a fortnightly basis from the date of your deposit.

Please mail us your cheque seperately and we will match your payment to your application

Please mail us your money order seperately and we will match your payment to your application

When you press the "Submit" button below you will be taken to our online credit card partners PayPal via the secure PayPal website to pay for your registration. Please ensure you continue through to the checkout.

Please list your direct deposit reference if you used one and we will match your payment to your application


Anti-Spambot Verification
Enter Verification code*

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Direct Deposit Details
If you are paying your registration fee by direct deposit please use the details below. Bank: Westpac Banking Corporation Acc Name: Pagan Awareness Network Inc. BSB: 032206 Acc Number: 167670 Address: Pagan Awarness Network PO Box 1062 North Sydney NSW Australia 2059

Registration Prices

	PAN / PA / CC Members*	Non-Members
Adult:	$260	$280
Presenter:	$220
Child (2-17):	$180
Infant (<2):	Free

Guest #1 Main Contact Registration Type *

Guest #1 Main Contact Personal Details *

Guest #2 Registration Type

Guest #2 Personal Details

Guest #3 Registration Type

Guest #3 Personal Details

Guest #4 Registration Type

Guest #4 Personal Details

Prefered Contact Method

Sharing a Lodge

By completing my registration to attend the Australian Wiccan Conference 2012, I assert the following *

Payment Details *

Anti-Spambot Verification