TAX INVOICE	QISEO Inc
Date of issue: 29 September 2000	ABN: 91 532 424 304

REGISTRATION FORM
QISEO CONFERENCE 2000

Miss/Ms/Mr/Mrs/Dr

First name		Surname
Position
Workplace
Address & Postcode

Phone		Fax
Email

Registration Fees Payable

Where applicable circle 'Yes' or 'No' and complete 'Payment' section. All prices quoted are GST inclusive. (To become a member complete the membership form).

		Cost	Payment
Registration fee (Member)	-	$275.00
Registration fee (Non-member)	-	$330.00
Attending President's Reception - Tues 17 Oct	Yes/No	-	-
Attending Conference Dinner - Wed 18 Oct	Yes/No	-	-
Payment for partner at Conference Dinner	-	$70.00
Attending Conference Breakfast - Fri 20 Oct	Yes/No		-
	Total Amount		$

Method of Payment

Direct debit of Education Queensland accounts
Credit Card
Cheque

Direct debit of Education Queensland account

I authorise the Learning and Development Foundation to debit the following account code:

Centre Code		Cost Element
Amount
Approving Officer
	Name/Position

	Signature

Credit card

For personal payments only:
Please charge:

Bank card

Visa

Mastercard

Cred Card Number:

Expiry Date: _____ /_____ Amount $________

Card Holders name (please print)
Signature

Cheque

Please make cheques payable to 'Education Queensland'.

Accommodation

I require accommodation to be booked.

Carlton Crest ($120.00/night) for ______ person/s on nights of _____________________________
Ibis Hotel ($95.00/night, includes bkfst) for ______ person/s on nights of _____________________________

(Accommodation costs are to be met by participants and settled privately prior to checking out.)

Return of registration form and payment

Registration and payment are due by FRIDAY 13 OCTOBER 2000.

If paying by direct debit or credit card PRINT this Registration Form and FAX it to the Learning and Development Foundation at 07 3237 1338.

If paying by cheque PRINT this Registration Form and MAIL it and the cheque to the following address:

Mark Cooper
Principal Project Officer
Learning and Development Foundation
Education Queensland
PO Box 33
BRISBANE ALBERT STREET Q 4002