Empowering Individuals and Families 
in the Human Services

Adelaide 3 August 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 are involved in

          Please summarise your interests in the human services

TYPES OF PARTICIPANT 

COST           
Consumers, individuals, families  $   33 (includes GST)
Self-help groups, support groups $   44 (includes GST)
Unfunded advocacy groups   $   55 (includes GST)
Funded advocacy organisations  $ 110 (includes GST)
Service providers      $  165 (includes GST)
Private sector, funders, social investors    $  187 (includes GST)
Government employees, researchers, consultants, academics $  198 (includes GST)

          I wish to attend Empowering Individuals and Families in the Human Services as a

         

 Please reserve my place and
            		  
I will send my cheque/money order to   Social Enterprise Partnerships,
2 Elm St, North Melbourne 3051

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

         

BACK TO CONFERENCE PAGE

          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 22 July 2005.

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