Customer Details First Name: * Last Name: * Your Email: * Your Phone Number: * Company Name: ABN: Address: Billing Address: (if different) Video Conference Details Date of Conference: *---12345678910111213141516171819202122232425262728293031 ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---201720182019 Room Hire Time: * 123456789101112:000510152025303540455055 AMPM Time Zone: *---AEST (QLD) - ends 1 Apr 2017AEDT (NSW, VIC, TAS, ACT) - ends 1 Apr 2017AWST (WA)ACST (NT) - ends 1 Apr 2017ACDT (SA) - ends 1 Apr 2017AEST (QLD, NSW, VIC, TAS, ACT) - 2 Apr to 1 Oct 2017ACST (NT, SA) - 2 Apr to 1 Oct 2017NZDT - ends 1 Apr 2017NZST - 2 Apr to 23 Sep 2017 Conference Duration: * 0123456789101112 Hours and 00153045 Minutes Location Details Brisbane CBD Chorus Call Australia: Level 8, East Tower, 410 Ann Street, Brisbane, QLD, 4000 Attendee name: * Attendee number: * Please Note: Point to Point IP connection is included with video room hire. If you will be connecting with more than one location or via ISDN, please provide those details in the additional information box below. Far Site Location Connection Type---IP dial inIP dial outISDN dial in IP/ISDN # Contact Name Contact Phone Contact Email Presenting Materials? (ppt etc.):---YesNo RecordingRequired?---YesNo Additional Information: * I confirm that information above is accurate (required).