Social Enterprise: 
NSW Networking and Collaboration 

26 July 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 sector you work in

TYPE OF REGISTRATION 

Member

Non-member

Unfunded Community Initiator $33 $77
Social Entrepreneur $55 $99
Third Sector  $121 $176
Academic /Researcher $143 $198
Government /Public Sector  $187 $220
Corporate Sector $187 $220

I will be attending as a

         

       MEMBERSHIP APPLICATION (optional)

I would also like to become a SEP member in this category (please check a box)
            
Community Partner - $77 p.a. (includes GST)
Unfunded community leaders and initiative-takers
Social Entrepreneur - $99 p.a. (includes GST)
Individual social entrepreneurs who can demonstrate enterprise achievements (Please include details of your achievements in the text box above)
Third Sector Partner - $187 p.a (includes GST)
Individuals in funded organisations in the third or community sector
Public Sector Partner - $242 p.a. (includes GST)
Individuals in government and public sector agencies
Corporate Associate - $286 p.a. (includes GST)
Individuals in private sector organisations 
Consulting Associate - $286 p.a. (includes GST)
Individuals in consultancy organisations 
Research Associate - $286 p.a. (includes GST)
Individuals in research or academic organisations 
Student Associate - $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

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

         

BACK TO SEMINAR 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 8 July 2005.

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