Hotham Mission Hall
           4 Elm Street, North Melbourne
           10am - 1pm

           Please provide the following contact information

Name
Title
Organisation
Work Phone
Fax
Email

Address
Address
City
State	QLD NSW ACT VIC TAS SA WA NT N/A
Postcode
Country

           Please describe your current interests in this area

TYPE OF REGISTRATION	Amount
Families in Partnership Members	Free
Families (Non-FIP Members)	$44
Support Groups, Unfunded Advocacy Groups	$55
Service Providers, Funded Advocacy Groups	$110
Government /Public Sector	$132

Select your type of registration

          Families in Partnership Members Families (Non-FIP Members) Support Groups, Unfunded Advocacy Groups Service Providers, Funded Advocacy Groups Government /Public Sector
            

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.