Registration Form CON 16
This form is your Tax Invoice / Receipt of registration fees
ABN: 43 495 749 524
All prices on this form are in Australian dollars and are inclusive of Goods & Services Tax (GST)
Please add the number of registrations in the left hand column.
*Special: Two or more registrations from the same Special Education Program when one is a QASEL
member or Three or more registrations from a Special School when one person is a member of QASEL.
Please note that a $50 reduction in Conference Registration fo r ONE Presenter per workshop will be given
NonSpecial
Complete
Code
Early Bird – payment up to Friday 22 nd April, 2016
Member
Below
Member
*
3 Day Registration – which includes: 3 day (1 st , 2 nd
A
and 3 rd June) Conference keynotes and workshops;
Welcome Reception on Wednesday evening June 1 st
$700
$800
$700
Conference Dinner with Keynote Speaker and some
complimentary drinks on Thursday evening, June 2 nd .
Full-Time University Student attendance – which
B
includes: 3 day (1 st , 2 nd and 3 rd June) Conference
keynotes and workshops; Welcome Reception on
$650
$650
Wednesday evening June 3 rd Conference Dinner with
Keynote Speaker and some complimentary dr inks on
Thursday evening, June 2nd.
Wednesday One Day attendance – which includes:
C
Conference keynotes and workshops; Welcome
$400
$500
$400
Reception on Wednesday evening June 1 st .
Thursday One Day attendance – which includes:
D
Conference keynotes and workshops; Conference
$400
$500
$400
Dinner with Keynote Speaker and some
complimentary drinks on Thursday evening, June 2 nd .
Friday One Day attendance – which includes:
E
Conference keynotes and workshops on Friday, June $300
$400
$300
3 rd , 2016.
F
Conference dinner for additional guests
$85
$95
Complete
Below
Code
G
H
I
J
K
L
Late Bird – payment after Friday 22 nd April, 2016
3 Day Registration – which includes: 3 day (1 st , 2 nd
and 3 rd June) Conference keynotes and workshops;
Welcome Reception on Wednesday evening June 1 st
Conference Dinner with Keynote Speaker and some
complimentary drinks on Thursday evening, June 2 nd .
Full-Time University Student attendance – which
includes: 3 day (1 st , 2 nd and 3 rd June) Conference
keynotes and workshops; Welcome Reception on
Wednesday evening June 1 st Conference Dinner with
Keynote Speaker and some complimentary dr inks on
Thursday evening, June 2 nd .
Wednesday One Day attendance – which includes:
Conference keynotes and workshops; Welcome
Reception on Wednesday evening June 1 st
Thursday One Day attendance – which includes:
Conference keynotes and workshops; Conference
Dinner with Keynote Speaker and some
complimentary drinks on Thursday evening, June 2 nd .
Friday One Day attendance – which includes:
Conference keynotes and workshops on Friday, June
3 rd , 2016.
Conference dinner for additional guests
Member
Non
Member
Special
*
$800
$900
$800
$700
$700
$500
$600
$500
$500
$600
$500
$400
$500
$400
$100
$110
Registration Form CON 16
Please either type in responses or use CAPTIALS to complete this form.
It is recognised that some schools will purchase one full 3 day registration but send two or three different
people across the three days.
If this is the case for you, please note – The name of the person who is attending on the
WEDNESDAY, is to be registered on the form below and is known as the 'registered' person.
The name of the person attending on the Thursday or Friday is known as the 'participant'.
Name of School
Name of person making payment
Email of person making payment
Method of payment (see next page)
Phone and Fax number of School
Name of 1 st person registered
Code of Registration
Email of 1 st person registered
Dietary &/or Access requirements
Are you coming to Welcome Reception?
Are you coming to dinner Thursday?
Name of Thursday participant if applicable
Name of Friday participant if applicable
Name of 2 nd person registered
Code of Registration
Email of 2 nd person registered
Dietary &/or Access requirements
Are you coming to Welcome Reception?
Are you coming to dinner Thursday?
Name of Thursday participant if applicable
Name of Friday participant if applicable
Name of 3 rd person registered
Code of Registration
Email of 3 rd person registered
Dietary &/or Access requirements
Are you coming to Welcome Reception?
Are you coming to dinner Thursday?
Name of Thursday participant if applicable
Name of Friday participant if applicable
Name of 4 th person registered
Code of Registration
Email of 4 th person registered
Dietary &/or Access requirements
Are you coming to Welcome Reception?
Are you coming to dinner Thursday?
Name of Thursday participant if applicable
Name of Friday participant if applicable
Yes / No
Yes / No
Email:
Email:
Yes / No
Yes / No
Email:
Email:
Yes / No
Yes / No
Email:
Email:
Yes / No
Yes / No
I do not want my details made available to conference sponsors.
Email:
Email:
Registration Form CON 16
This form is your Tax Invoice / Receipt of registration fees
ABN: 43 495 749 524
All prices on this form are in Australian dollars and are inclusive of Goods & Services Tax (GST)
Please note that a $50 reduction in Conference Registration for ONE Presenter per workshop will be given
CREDIT CARD PAYMENT
Please note that a surcharge of 2% will be added for payments made by credit card.
Name of Person and/or school registered:
Master card
Card Holder’s name:

Visa Card
Amount: $ ___________ + 2% $ ______________ = $
___________________
Card Number:
   
Card Verification Number:
Signature:


Expiry Date:
 
Date:
CHEQUE PAYMENT
Cheque payments should be made payable to QASEL Inc.
Please mail with your Registration Form to to
[email protected]

ELECTRONIC FUNDS TRANSFER PAYMENT
OneSchool Supplier Code S20001912
Account Name: QASEL – Queensland Association of Special Education Leaders Inc
Bank: QTMB – QT Mutual Bank BSB: 804 002 Account Number: 1208947
It is important when making an electronic funds transfer payment you insert the name of the
Registered person / school (not the paying person) in the details section.
Please print off the details of the transfer and/or your online banking receipt number and forward
it to the Treasurer.
Forward this Registration Form to: [email protected]
Registration Form CON 16
QASEL Conference Cancellation Policy
By completing a registration you are indicating your intention to attend the conference and you will
be liable for a cancellation fee if you are unable to attend.
Registration cancellations must be sent in writing (email), to the QASEL Treasurer, Nicole Finch
at [email protected]
Registration cancellations received up to 30 days prior to the conference or professional
development will receive a full refund, less a $50.00 handling fee.
Registration cancellations received less than 30 days and up to seven days prior to the conference
or professional development will receive a 50% refund.
No refunds will be given for registration cancellations received within seven days of conference;
however a substitute delegate may be nominated.
Refunds from any deposits forwarded to hotels, tour companies or other related business will be at
the discretion of the supplier.