ECTA Julie Cross Regional Tour ECTA Brisbane Regional Group Tax Invoice / Registration Form ABN: 31 930 635 743 Date/Time: 5pm 27 February, 2017 (Note new session times) Griffin State School RSVP Due: 20 February, 2017 IMPORTANT: This form is your tax receipt upon payment. School/Centre/Organisation: ECTA Qld Membership No: Order Number if applicable: To be paid by: Contact name for these registrations: Contact Phone Number: Email address for receipt confirmation: Personal details for each attendee Session 1 Session 2 Session 1 & 2 What rate are One / Two Leadership It’s all about 5pm - 8.30pm you paying? sessions an inside You! ECTA QLD ($10 / $15) Job 7pm-8.30pm Regional Group ($20 / $30) 5pm-6.30pm Non-Member ($40 / $50) Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Total Payable $ Please return the completed registration form via to brisbanenorthrg@ecta.org.au or post to Terrianne Loth c-/ Samford State School, Samford 4520 Payment Details
ECTA Julie Cross Regional Tour ECTA Brisbane Regional Group Tax Invoice / Registration Form ABN: 31 930 635 743 Date/Time: 5pm 27 February, 2017 (Note new session times) Griffin State School RSVP Due: 20 February, 2017 IMPORTANT: This form is your tax receipt upon payment. School/Centre/Organisation: ECTA Qld Membership No: To be paid by: Order Number if applicable: Contact name for these registrations: Contact Phone Number: Email address for receipt confirmation: Personal details for each attendee Session 1 Leadership an inside Job 5pm-6.30pm Session 2 It’s all about You! 7pm-8.30pm Session 1 & 2 5pm - 8.30pm What rate are you paying? One / Two sessions ECTA QLD ($10 / $15) Regional Group ($20 / $30) Non-Member ($40 / $50) Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Total Payable $ Please return the completed registration form via to brisbanenorthrg@ecta.org.au or post to Terrianne Loth c-/ Samford State School, Samford 4520 Payment Details
Brisbane-JulieCross-RegionalTour2017registrationForm.docx