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 event:

TYPE OF REGISTRATION	Member	Non-member
Individuals and families (self-funded)	Free	$66
Groups (self-help, advocacy, community)	$66	$220
Service providers	$220	$440
Commercial (trainers, consultants, planners)	$110	$550
Government	$220	$660
Sponsors	Free

I will be attending as a

          Please choose Government employee Sponsor Commercial trainer, consultant or planner Service provider Group - self-help, community or advocacy Unfunded individual or family member


Membership Application (optional)

I would also like to become a member. (For information on Member benefits, please CLICK HERE. Close the window when you are ready to return to this form.)
INDIVIDUAL AND FAMILY MEMBERSHIP		Fee
General		$55
Set-up fee (first year only)		$220
Annual fee in second or subsequent years		$55
My agency/company/department wishes to join as an organisational member. (Please click on the appropriate box below..)
ORGANISATIONAL MEMBERSHIP		Annual Fee
	Groups with an annual revenue less than $100K	$55
	Groups with an annual revenue more than $100k	$220
	Providers with an annual revenue less than $2m	$660
	Providers with an annual revenue between $2m and $5m	$2640
	Providers with an annual revenue more than $5m	$6660
	Commercial - Single practitioner	$1100
	Commercial - Companies with two or more practitioners	$2200
	Local governments	$8800
	Statutory agencies	$2640
	State and federal departments	$22000
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
		PO Box 159
		Yarraville VIC 3013
		(Cheque payable to Social Enterprise Partnerships)
OR

	I will pay by EFT transaction:	Bank: Commonwealth Bank of Australia Account name: Social Enterprise Partnerships Ltd BSB: 062 218 Account number: 1007 2945
	Please send a tax invoice.

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: Applicants are asked to read the membership categories carefully and select the appropriate one. We reserves the right to amend the registration/membership category indicated on this form if it is not correct. 3. Cancellations must be notified in writing by 7 March, 2009. For cancellations received after 7 March, 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  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 PO Box 159 Yarraville Vic 3013