CCAA Advanced Concrete Technology Course 2011/2012

APPLI CATION S MUST BE RE CEIV ED BY 31 s t Ma y 2011

Post or Fax Applications to: Advanced Concrete Technology Course Cement Concrete & Aggregates Australia Locked Bag 2010, St Leonards, NSW 1590 Fax: 02 9437 9470

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

Delegate Details:
Title & Initials: Company: Street: Suburb: Telephone: Email: State: Fax: Date of Birth: Postcode: Mobile No.: Sex: M: F: First Name: Surname:

Postal address if different from above:

Qualifications:
Education Qualifications: Tertiary Qualifications: Degrees, Diplomas, Certificates (State Level or Grade) Awarding Body Date Obtained

Experience:

Please provide & attach the following information for each position held: Dates, position, level of responsibility, type & nature of work. (Note: A normal CV is unlikely to provide sufficient detail) CCAAs Aggregates & Concrete Technical Committee will review and approve all applications to ensure that course delegates have the necessary experience to undertake this demanding course please see Course Overview for further details of Entry Requirements.

Details of person responsible for sending you on the course:

Name: Telephone: Email: Signature: Date: Fax: Position: Mobile No.:

Details of person to receive delegates results, if different from person responsible for sending you on course.

Name: Address:

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CCAA Advanced Concrete Technology Course 2011/2012

Course Fees:
CCAA Members: Australian Residents: Non Australian Delegates:

$11,550-00 $12,100-00 $12,650-00

per delegate (incl. GST) per delegate (incl. GST) per delegate (incl. GST)

A 50% deposit is payable before 31/5/2011 and final payment is due before 15/10/2011. The course fee includes all tuition costs , examination fees , tea/coffee & luncheon during lectures & site visits, but does NOT include travel or accommodation/meal costs. (CCAA will negotiate rates at suitable hotels on behalf of delegates)

Invoicing Details:

Please attach a copy of your company purchase order to this form.

Person responsible for payment: Company Name: Address:

Method of payment:
No. of delegates: A) Cheque:

(Please tick applicable box in A), B) or C) below)

Amount Paid: $
Please make payable to: Cement Concrete & Aggregates Australia

B) Credit Card: MasterCard: Cardholder Name: Card No.:

Expiry Date: /

Visa:

Signature: C) Direct Deposit:

(Please include description: Advanced Concrete Technology Course)

Account No.: 032 099 24 6479 Westpac North Sydney Direct deposit into the CCAA bank account must be validated by faxed or emailed copy of the transaction slip, clearly identifying the delegate(s), course and your company with each payment. Please include invoice number if available and fax or email details to: Ilze Beyers (02) 9437 9470 or: ilze.beyers@ccaa.com.au

IMPORTANT INFORMATION:
50% deposit is payable before 31/5/2011 & final payment is due before 15/10/2011. Registration will only confirmed upon receipt of a purchase order or deposit. Delegates will be invoiced upon receipt of a purchase order or payment. Course fees include comprehensive course notes. Course fees are not refundable once course material has been despatched. Please direct enquiries to: John Turton: ph: 02-99037751, or john.turton@ccaa.com.au

CONFIRMATION OF DETAILS:
Signature: Name: Date:

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