act 2011-2012 registration

7/28/2019 ACT 2011-2012 Registration

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CCAA Advanced Concrete Technology Course – 2011/2012 

 APPLICATIONS MUST BE RECEIVED BY 31s t May 2011 

Post or Fax App l icat ions to:  Advanced Concrete Technology CourseCement Concrete & Aggregates Austra l ia

Locked Bag 2010, St Leonards, NSW 1590Fax: 02 9437 9470

 ALL DETAILS BELOW ARE REQUIRED. IF THE APPLICATION IS NOT COMPLETE YOUCANNOT BE REGISTERED.

Delegate Details: 

Title &  Initials: First Name: Surname:  

Company:  

Street:  

Suburb: State: Postcode:  

Telephone: Fax: Mobile No.:  

Email: Date of Birth: Sex: M: F:  

Postal address i f d i f ferent from above:

Qualifications: 

Education Qualifications:  

Tertiary Qualifications:  

Degrees, Diplomas,  Certificates (StateLevel or Grade) 

 Awarding Body  Date Obtained 

Experience: Please prov ide & at tach the fo l lowing informat ion for each pos i t ion held: Dates, pos i t ion, leve l of  responsib i l i t y , type & nature of work . (Note: A normal CV is un l ike ly to prov ide suf f i c ient deta i l )CCAA’s Aggregates & Concrete Technica l Commit tee w i l l rev iew and approve a l l app l icat ions to ensurethat course delegates have the necessary exper ience to undertake th is demanding course – p lease see Course Overv iew fo r fur ther deta i l s of En t ry Requi rements .

Details of person responsible for sending you on the course: 

Name: Position:  

Telephone: Fax: Mobile No.:  

Email:  

Signature: Date:  

Deta i l s of person to rece ive delegate ’s resu l t s , i f d i f ferent f rom person responsib le for send ing youon course .

Name:  

 Address:  

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7/28/2019 ACT 2011-2012 Registration

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CCAA Advanced Concrete Technology Course – 2011/2012 

Course Fees:

CCAA Members:  $11,550-00 per delegate ( inc l . GST)

 Australian Residents:   $12,100-00 per delegate ( inc l . GST)

Non Australian Delegates:   $12,650-00 per delegate ( inc l . GST)

 A 50% deposi t i s payab le before 31/5/2011 and f ina l payment i s due be fore 15/10/2011.The course fee inc ludes a l l tu i t ion costs , examinat ion fees , tea/cof fee & luncheon dur inglectures & s i te v is i t s , but does NOT inc lude t ravel or accommodat ion/meal costs.(CCAA wi l l negot iate rates at su i tab le hote ls on behal f of de legates)

Invoicing Details: Please attach a copy of your company purchase order to th is form.

Person responsible for payment:  

Company Name:  

 Address:  

Method of payment: (P lease t ick  appl icab le box in A) , B) or C) be low) 

No. of delegates: Amount Paid: $

 A) Cheque: Please make payab le to: Cement Concrete & Aggregates Aust ra l ia  

B) Credit Card: MasterCard: Visa:

Cardholder Name:

Card No. : / / /

Expiry Date:  /

Signature:

C) Direct Deposit: (P lease inc lude descr ipt ion: “Advanced Concrete Technology Course”)  

 Account No . : 032 099 24 6479 – Westpac North Sydney

Direct deposi t into the CCAA bank account must be va l idated by faxed or emai led copy of thet ransact ion s l ip , c lear ly ident i fy ing the delegate(s) , course and your company wi th each payment .P lease inc lude invoice number i f ava i lab le and fax or emai l deta i l s to:I l ze Beyers (02) 9437 9470 or: i l ze.beyers@ccaa.com.au

 IMPORTANT INFORMATION: 

♦  50% depos i t i s payab le before 31/5/2011 & f ina l payment i s due before 15/10/2011.  

♦  Registrat ion wi l l only conf i rmed upon receipt of a purchase order or deposi t .

♦  Delegates wi l l be invoiced upon receipt of a purchase order or payment.

♦  Course fees inc lude comprehensive course notes.♦  Course fees are not refundable once course mater ia l has been despatched. 

♦  Please di rect enquir ies to: John Turton: ph: 02-99037751, or  john.turton@ccaa.com.au  

CONFIRMATION OF DETAILS:  

Signature: Date:  

Name:  

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