WA Chapter Summit Partner/Exhibitor Application Form HomeWA Chapter Summit Partner/Exhibitor Application Form WA Chapter Summit Partner/Exhibitor Application Form Organisation name:(Required) Contact name:(Required) Position :(Required) Postal address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone:Mobile:Email:(Required) Partnership items value GST total. We confirm the following Partnership item/s:All Partnership packages are in Australians dollars and are subject to GST. The prices displayed are exclusive of GST (GST will be added to your final invoice)Chapter Partner (two available) Quantity Price: $ 7,500.00 Quantity price displayed is exclusive of GSTSocial Event Partner (one available) Quantity Price: $ 3,500.00 Quantity price displayed is exclusive of GSTLanyard Partner (one available) Quantity Price: $ 2,000.00 Quantity price displayed is exclusive of GSTSatchel Partner (one available) Quantity Price: $ 2,000.00 Quantity price displayed is exclusive of GSTLunch Partner (one available) Quantity Price: $ 1,500.00 Quantity price displayed is exclusive of GSTNetworking Break Partner (two available) Quantity Price: $ 1,000.00 Quantity price displayed is exclusive of GSTSession Partner (20 available) Quantity Price: $ 750.00 Quantity price displayed is exclusive of GSTExhibitor (20 available) Quantity Price: $ 1,250.00 Quantity price displayed is exclusive of GSTNewcomer Scholarship Partners (two available) Quantity Price: $ 1,000.00 Quantity price displayed is exclusive of GSTIn-Kind Support Please contact Susie Gill to discuss your proposal.WOW Idea Please contact Susie Gill to discuss your proposal.Total price displayed is exclusive of GSTConsent(Required) I/We are authorised to sign documents on behalf of the Organisation and I/we acknowledge that I/we have read the conditions and regulations contained in the WA Partnership Prospectus and agree to be bound by them and comply with them in full.Name(Required) First Last Date of application(Required) MM slash DD slash YYYY
