Please complete this form then use File > Print in your browser to print it.
Alternatively, contact the convenor or download a printable version, here

REGISTRATION FORM/TAX INVOICE

Please register me for the 10th State Conference of the Queensland Association for Gifted & Talented Children Inc,
from Friday 23rd March to Sunday 25th March 2001 in Hawken Engineering Building, University of Qld, St Lucia.

Name:

Name for badge:

Email:

Phone, Home:

Work:

 Fax:

Mailing Address:

Town/suburb:

Postcode:

School Address:

Town/suburb:

Postcode:

Full registration includes

Full Registration:

Part Registration:

Part Registration:

Children's program:

Number on Saturday: on Sunday: @ $22/child/day

 Additional convivium tickets for non-registrants: @ $11 each

 Prices include 10% GST (QAGTC Inc. ABN: 46 866 103 154) Total amount  

 This document will be a tax invoice when you make payment. Please retain an original copy.
* for membership information, please see   www.qagtc.org.au

Vegetarian lunch please.                 I would appreciate accommodation information.

If paying by credit card,   MasterCard: BankCard: Visa:
Name on card: 
Card No.:

Expiry Date:

Signature:
If paying by cheque, please make the cheque payable to QAGTC Inc.

Mail to:    QAGTC Inc, 282 Stafford Rd, Stafford, Qld 4053
  (Payment with registration, by 17th March, please. Late registration does not include lunch!)