Registration and Payment Form   

[ For further information on the Conference, 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

Cost

DINNER WITH NOEL PEARSON   7pm May 16 (not included in conference fee)	Conference Registrants	Non- Registrants
Unfunded - Unfunded consumers (individuals,families), volunteers	$44	$55
Third Sector - Staff of funded organisations	$55	$88
Public Sector - Staff of government and public sector agencies	$55	$110
Small Business - Staff of businesses employing up to 10 people	$55	$88
Corporate - Staff of businesses employing more than 10 people	$55	$110
Full-time Student	$44	$55

I am registering as a   (please choose) Unfunded Attendee Unfunded Non-attendee Third Sector Attendee Third Sector Non-Attendee Public Sector Attendee Public Sector Non-Attendee Small Business Attendee Small Business Non-Attendee Corporate Attendee Corporate Non-Attendee Student Attendee Student Non-Attendee at the conference
 

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

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 1 May 2006. Social Enterprise Partnerships Ltd ABN 47108742098 2 Elm Street North Melbourne Phone (03) 9326 4481 Fax (03) 9326 8030