ECTA Townsville Regional Group

ECTAJulie Cross Regional Tour

ECTA Townsville Regional Group

Tax Invoice/Registration Form

ABN: 31930635743

Date/Time:Tuesday 21st March 2017

Venue:JCU Education Central Lecture Theatre, Building 134-010 campus map:

RSVP Due:Wednesday 1st March 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
It’s all about You!
5pm-6.30pm / Session 2
Leadership an inside Job
7pm-8.30pm / Session 1 & 2
5pm - 8.30pm / What rate are you paying?
ECTA QLD / ($10/ $15)
Regional Group / ($20/ $30)
Non-Member / ($40 or
$50 for 2 sessions)
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 to
or post toECTA Townsville regional group c/o PO Box 277 , Aitkenvale QLD 4814
Payment Details
☐Direct Deposit / ECTA Townsville Regional Group
Bank of Qld| BSB 124 001| A/C #21638949
Supplier #S20038615 (to be used by EQ to pay ECTA) / 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 email if you wish to organise cash payment

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.