ECTA Brisbane North Regional Group

ECTAJulie Cross Regional Tour

ECTA Brisbane North Regional Group

Tax Invoice/Registration Form

ABN: 31 930 635 743

Date/Time: 5pm 27 February, 2017 (Note new session times)

Venue: Griffin State School

RSVP Due: 20 February, 2017

IMPORTANT: This form is your tax receipt upon payment.

School/Centre/Organisation: Click here to enter text. / ECTA Qld Membership No: Click here to enter text.
To be paid by:Click here to enter text. / Order Number if applicable:Click here to enter text.
Contact name for these registrations: Click here to enter text. / Contact Phone Number:Click here to enter text.
Email address for receipt confirmation:Click here to enter text.
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:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Name:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Name:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Name:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Name:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Name:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Name:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Name:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Name:Click here to enter text. / ☐ / ☐ / ☐ / Click here to enter text. / Click here to enter text.
Email:Click here to enter text.
Total Payable / $ Click here to enter text.
Please return the completed registration form via email toor post toTerrianne Loth c-/ Samford State School, Samford 4520
Payment Details
☐Direct Deposit / ECTA ……. Regional Group
Bank of Qld| BSB 124 001| A/C # 22106992
EQ Supplier # S20038621 / Transfer ID used:
Click here to enter text. / Date deposited:
Click here to enter text.
Individuals use initial and surname - School/Centre/Organisations use name
☐ Credit Card /
☐ Cash / Please deliver in person to Terrianne Loth – Samford State School

Please read the following important information
Full payment must be received with registration to confirm attendance. Refunds will be issued, with written notice, up to 7 days prior to the event. No refunds will be issued for cancellations within 7 days of the event, however substitutions will be accepted.