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AJC Convention Centre, Randwick Racecourse
Alison Road, Randwick
19 and 20 October 2006
Registration Form
Download registration form or print this page and post, fax or email this form to:
TAFE NSW International Centre for VET Teaching and Learning
ABN: 91 424 139 683
Locked Bag 53 Darlinghurst NSW 2010
Ph 02 9244 5111 Fax 02 9244 5925
Email: silva.klein-beernink@tafensw.edu.au
Title_____________ First Name _______________________________________
Suburb ___________________________________________________________
Post Code ________________________________________________________
Phone ________________________________ Mobile _____________________
Fax _____________________________________________________________
Surname _________________________________________________________
Position __________________________________________________________
Division __________________________________________________________
Organisation ______________________________________________________
Street Address ____________________________________________________
Email ____________________________________________________________
I wish to attend the following keynote presentation/s:
[ ] Nancy White Keynote Presentation Thursday 19 October 2006, 12.00 noon – 2.00pm, |
No of Tickets: _____ Cost $ _____ |
[ ] George Siemens Keynote Presentation Friday 20 October 2006, 12.30pm noon – 2.30pm, |
No of Tickets: _____ Cost $ _____ |
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Total Cost: $ _____ |
Payment Details
I wish to pay $ .......................... by:
[ ] Cheque (payable to TAFE NSW Illawarra Institute)
[ ] Credit Card
[ ] Master Card [ ] Visa [ ] Diners [ ] AMEX
Card Number ................................................................
Expiry Date ...................................................................
Name on Card ..............................................................
Signature .....................................................................
[ ] I am attending on behalf of LearnScope Project Team No ................................ Cost $0
[ ] Please invoice me
Signature ...................................................................
Consent to reproduce photograph/video images & audio
During eLearning 06 we will record the event using a range of media that can be used for reporting, promotion and to share your learning with others.
By signing below, you consent to TAFE NSW ICVET, LearnScope and the Flexible Learning Framework using and publishing your name and the photographs and/or videos, including your voice to be used for educational, reporting and promotional purposes. I understand that this may include photos in publications and shared on websites, edited video footage, and MP3 recordings and podcasts.
Signature ....................................................................
Download registration form or print this page and post, fax or email this form to:
TAFE NSW International Centre for VET Teaching and Learning
ABN: 91 424 139 683
Locked Bag 53 Darlinghurst NSW 2010
Ph 02 9244 5111 Fax 02 9244 5925
Email: silva.klein-beernink@tafensw.edu.au