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SEN Conference 2001 Online Registration

Working at the Sharp End - The 2nd Australia New Zealand Social Entrepreneurs Conference

Location: Melbourne, Australia
Carlton Crest Hotel 4 - 5 March 2002

Instructions on how to fill out this form.

Taxation Invoice ABN No. 31 095 112 913
SECTION A: Delegate (A separate application form must be completed for each delegate)
Title: Mr Mrs Ms
Firstname:
Surname:
SEN Member? Yes No
Organisation Name:
Position Title:
Street Address:
Suburb/Town:
State: Postcode
Country:
Telephone: Fax: Mobile:
Email:
Special Requirements
(eg. dietary, disability)
SECTION B: Registration Fees (inclusive of GST)
  Early Bird (by 24/12/01) Standard (After 24.12.01)
SEN Member $300 $350 $AUD
Non-Member $350 $395 $AUD
SECTION C: SEN Annual Membership Application Fee
Standard $ 99 $AUD
Concession/Student $ 33 $AUD
SECTION D: Members Dinner (inclusive of GST)
Member delegate,
(if attending)
$75 $AUD
No. of non-member guests guests @ $90 each $AUD
SECTION E: Payment (Please make all cheques payable to SEN)
       
Payment Section B Registration Fees subtotal: $AUD
Payment Section C Membership Fee subtotal: $AUD
Payment Section D Members Dinner subtotal: $AUD
TOTAL AMOUNT DUE: $AUD
SECTION F: Credit Card Payment / Direct Credit Transfer
Direct Credit Transfer Bendigo Bank: BSB No. 633-0000, A/C No. 112 669 429
Credit Card Payment Visa Mastercard Bankcard (Aust only)
Cardholders Name:
Credit Card Number:
Expiry Date: mm/yy format, e.g., 09/02
Your Email: A receipt will be sen-devt to this email address

The BAMA ISX is not a financial market and does not sell or trade financial products of any kind.


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