Churches, Social Capital and Social Enterprise 

Tuesday 14 June 2005

Registration and Payment Form 

           Please provide the following contact information

Name
Title
Organisation
Work Phone
Fax
Email
 Address
Address 
City
State
Postcode
Country

           Please describe your current role and the area you work in

TYPE OF REGISTRATION 

Member

Non-member

Parish /Congregation /Community $55 $99
Church Agency  $132 $176
Private Sector $154 $198
Government /Public Sector $154 $198
Academic /Researcher  $132 $176

Registration includes key papers, lunch, morning and afternoon teas.

Select your type of registration

         

       
          MEMBERSHIP APPLICATION (optional)

I would also like to become a SEP member in this category (please check a box)
            
Community Partner - $77 p.a. (includes GST)
Unfunded community leaders and initiative-takers
Social Entrepreneur - $99 p.a. (includes GST)
Individual social entrepreneurs who can demonstrate enterprise achievements (Please include details of your achievements in the text box above)
Third Sector Partner - $187 p.a (includes GST)
Individuals in funded organisations in the third or community sector
Civic Entrepreneur - $242 p.a. (includes GST)
Individuals in government and public sector agencies
Corporate Associate - $286 p.a. (includes GST)
Individuals in private sector organisations 
Consulting Associate - $286 p.a. (includes GST)
Individuals in consultancy organisations 
Research Associate - $286 p.a. (includes GST)
Individuals in academic or research organisations 
Student Associate - $33 p.a. (includes GST)
Full-time students
                 
For information on Member benefits, please CLICK HERE. (Close the window when you are ready to return to this form.) 
 Please reserve my place and
            		  
I will send my cheque/money order to   Social Enterprise Partnerships,
2 Elm St, North Melbourne 3051
OR  
I will make a payment using the secure online credit card payment facility
(Visa/Bankcard/Mastercard accepted) CLICK on this link NOW to use our secure payment system. Then close the window and submit this form. 

I understand that a tax invoice/receipt will be forwarded to me on receipt of payment.

         

BACK TO WORKSHOP OUTLINE

          PRIVACY STATEMENT:  Registration details will be held in the strictest confidence and
          will not be passed onto a third party.

          CANCELLATIONS:  Cancellations must be notified in writing by 7 June 2005.

          Social Enterprise Partnerships Ltd
          ABN 47108742098
          2 Elm Street
          North Melbourne
          Phone (03) 9326 4481
          Fax (03) 9326 8030