Your details

* required field

*First name

*Family name

*School/Institution/Organisation

*Postal address

*Town

*Postcode

*Phone (BH)

Fax (BH)

*Email
(this email address will be used for all correspondence)

Any special needs we should know about

Indicate which sector you're from *

Catholic School

Government School

Independent School

TAFE

ACE

Representing a community organisation?

Which org?

Region?

If a school, indicate in which region your school is located

Eastern Metropolitan

Northern Metropolitan

Southern Metropolitan

Western Metropolitan

Barwon-South Western

Gippsland

Loddon Campaspe/Mallee

Hume

Grampians

Registration fee

Must be accompanied by either purchase order or payment (cheque, credit card, online or direct).
All fees include GST

Member**

$120

Non-Member

$150

Purchase Order (if any)

** Member rate only applies to Individual members and, for Organisation members, up to four people from the same organisation. You must be a financial member at the time of registration. You can download a membership form (PDF 80KB) and send it in with your registration.

Payment method

Online - I'll pay online now using PayMate secure services, a small fee applies. (You'll be taken to a payment page when you submit this form)

Registrations are not valid unless accompanied payment or a purchase order.

Credit card - I'll complete the print version of this form and send by post of fax with credit card details (MasterCard or VisaCard). Alternatively you may complete the form online and give credit card details via phone 03 9546 6892 or fax 03 9546 0421 (no cover sheet required). I understand that my registration is not accepted until payment has been received.

Cheque - I'll post a cheque to VALA, please send an invoice to the email address provided. I understand that my registration is not accepted until payment has been received. Make cheque payable to ‘VALA’ and send to Box 938, Springvale South VIC 3172

Direct into VALA account - A payment will made direct into the VALA account: I will advise VALA of the payment quoting the surname of the participant to allow correct attribution. Bank Account: ‘VALA’ Commonwealth BSB 063-012 A/c 10306090. I understand that my registration is not accepted until payment has been received.

Purchase Order No. The order number is given above; VALA will send an invoice promptly. Alternatively you can post or fax an purchase order to the address below. I understand that my registration is not accepted until the purchase order has been received.