Registration and Payment Form   

[ For further information, CLICK HERE ]

Please provide the following contact information

Name
Title
Organisation
Work Phone
Fax
Email

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

Please describe your current role and your interest in this Summit

TYPE OF REGISTRATION	SEP Member	Non-member
Individuals/groups without income and/or third sector volunteers	$44	$77
Staff of community organisations	$220	$276
Staff of financial institutions with less than 12 staff	$220	$276
Staff of financial institutions with more than 12 staff	$330	$396
Funders and social investors	$330	$396
Staff of private sector organisations (includes consultants)	$330	$396
Staff of government and public sector agencies	$385	$440

I will be attending as a

          Please choose Unfunded group, individual Funded community organisation Financial institution (less than 12 staff) Financial institution (more than 12 staff) Funder/social investor Private sector organisation, consultant Public sector organisation, government


Membership Application (optional)

I would also like to become a SEP member. (For information on Member benefits, please CLICK HERE. Close the window when you are ready to return to this form.)
INDIVIDUAL MEMBERSHIP		Joining Fee
Unpaid community leaders and initiative takers and third sector volunteers		$99
Staff members of funded organisations in the third (or community) sector		$187
Staff of government and public sector agencies		$242
Staff of businesses employing up to 10 people		$187
Staff of businesses employing more than 10 people		$286
My organisation/agency/department wishes to join as a corporate member. (Please click on a box below to describe the nature/size of your operation.)
CORPORATE MEMBERSHIP		Annual Fee
	Not-for-profit and For-profit organisations	$550
	Government departments/agencies employing less than 100 people	$550
	Government departments/agencies employing more than 100 people	$1650
NOTE: All of the fees shown above include GST

Payment Options Please reserve my place and

	I will send my cheque/money order to   Social Enterprise Partnerships,
		2 Elm Street
		North Melbourne VIC 3051
OR

I will make a payment using our 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 have read, and accept the terms and conditions described below.

Terms and Conditions 1. Registration fees must be paid in full before the date of the event. 2. Type of Registration: With the exception of third sector volunteers (where the person concerned performs relevant services for a not-for-profit organisation from which s/he derives no income of any kind), registration and membership fees will be based on the nature of the attendee's primary source of employment. Social Enterprise Partnerships reserves the right to amend the registration/membership category indicated on this form. 3. Cancellations must be notified in writing by 15 February, 2006. For cancellations received after 15 February, full fees will apply. 4. Transfer of registration is permitted where necessary, to enable another person from the same organisation/department/group to attend the event in place of the person whose name is shown on the registration form. (Should you wish to take up this option, please advise Social Enterprise Partnerships on the change of name and contact details before the date of the event.) 5.. Privacy Statement: Registration details will be held in the strictest confidence and will not be passed onto a third party without the express permission of the attendee. Social Enterprise Partnerships Ltd ABN 47108742098 2 Elm Street North Melbourne Phone (03) 9326 4481 Fax (03) 9326 8030