CCAA Advanced Concrete Technology Course – 2011/2012A P P L I C A T I O N S MU S T B E R E C E I V E D B Y 3 1 s t May 2011 Post or Fax Applications to: A d v an c ed C o n c r e t e T echno l o g y C o u r s e Cement Concrete & Aggregates Australia Locked Bag 2010, St Leonards, NSW 1590 Fax: 02 9437 9470 A L L DE T A IL S B EL O W ARE R E Q UI R ED. IF T HE A P P L I C A T I O N IS N O T C O M P L E T E Y OU CANNOT 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 if different from above: Qualifications:Education Qualifications: Tertiary Qualifications: Degrees, Diplomas, Certificates (State Level or Grade) A w a r d i n g B o d y 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) CCAA’s Aggregates & Concrete Technical Committee will review and approve all applications to ensure that course delegates have the necessary experience to undertake this demanding course – p l e ase s e e C o u r s e O v e r v i e w f o r f u r t h e r d e ta i l s o f E ntr y R e q u i r e me nt s . Details of person responsible for sending you on the course:Name: Position: Telephone: Fax: Mobile No.: Email: Signature: Date: Details of person to receive delegate’s results, if different from person responsible for sending you on course. Name: A d d r e s s : Page 1 of 2
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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 .
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 [email protected]
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 [email protected]