Expiry Date: …………………………… Address: ……………………………………………………………………………………………………….… Phone: ………………………………… Amount to be debited: $........................... Signed: Date: ……………………………………………………………. ………………………… Please note: No information is kept after payment is finalised. A receipt will be sent to verify payment Please email this form to: SCHOOL NAME: ________________________________________________ STAFF NAME EMAIL ADDRESS COST (inc GST) @det.nsw.edu.au $55 TOTAL Please indicate payment method for yourself or school. PERSONAL DIRECT DEPOSIT $55.00 Please email this registration form to and directly deposit to: ANZ Bank Wauchope: BSB 012703 Account Number: 483381169 Account Name Women in Educational WC/Your name – – CREDIT CARD - please complete form on page 4 and this form to PERSONAL CHEQUE ($55.00) Registration form with cheque payment should be posted to Rose Pelley (see address above). Women in Educational Leadership Cheques must be made out to  SCHOOL CHEQUE
Expiry Date: …………………………… Address: ……………………………………………………………………………………………………….… Phone: ………………………………… Amount to be debited: $........................... Signed: ……………………………………………………………. Date: ………………………… Please note: No information is kept after payment is finalised. A receipt will be sent to verify payment Please email this form to: SCHOOL NAME: ________________________________________________ STAFF NAME EMAIL ADDRESS COST (inc GST) @det.nsw.edu.au $55 TOTAL Please indicate payment method for yourself or school. PERSONAL DIRECT DEPOSIT Please email this registration form to and directly deposit $55.00 to: ANZ Bank Wauchope: BSB 012703 Account Number: 483381169 Account Name – Women in Educational – WC/Your name CREDIT CARD - please complete form on page 4 and this form to PERSONAL CHEQUE ($55.00) Registration form with cheque payment should be posted to Rose Pelley (see address above). Cheques must be made out to Women in Educational Leadership  SCHOOL CHEQUE