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 the sector you work in

TYPE OF REGISTRATION	Member	Non-member
Unfunded - Unfunded consumers (individuals,families), volunteers	$110	$152
Third Sector - Staff of funded organisations	$330	$396
Public Sector - Staff of government and public sector agencies	$396	$495
Small Business - Staff of businesses employing up to 10 people	$330	$396
Corporate - Staff of businesses employing more than 10 people	$396	$495
Full-time Student	$99	$132

TYPE OF REGISTRATION

   Please choose Unfunded Third Sector Public Sector Small Business Corporate Full-time Student

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 would like to attend the Dinner on May 16 (please check the box)

MEMBERSHIP APPLICATION (optional)

	I would also like to become a SEP member in this category (please check a box)
		Unfunded - $99 p.a. (includes GST) Unfunded community leaders and initiative-takers, third sector volunteers
		Third Sector - $187 p.a (includes GST) Staff of funded organisations in the third or community sector
		Public Sector - $242 p.a. (includes GST) Staff of government and public sector agencies
		Small Business - $187 p.a. (includes GST) Staff of businesses employing up to 10 people
		Corporate - $286 p.a. (includes GST) Staff of businesses employing more than 10 people
		Student - $33 p.a. (includes GST) Full-time students
For information on Member benefits, please CLICK HERE. (Close the window when you are ready to return to this form.)

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