FPQ DISABILITY / ACCREDITED TRAINING Course Registration Form

This form is designed to be completed, printed and posted/faxed with payment or contact FPQ 07 3250 0240.

Post: Family Planning Queensland, PO Box 215, Fortitude Valley, Qld 4006
ABN 61 009 860 164
Fax: 07 3250 0294

I understand that by lodging this form I am agreeing to Family Planning Queensland's Terms and Conditions on Course Registration.

Below courses are run in Brisbane unless otherwise indicated:

Date:
Contact Name:	Title	Mr Mrs Miss Dr
Organisation:
Address:
Phone:	Mobile:
Fax:	E-mail:
FPQ will keep you updated about FPQ courses and news via e-mail.
No, I don't want to receive updates/news.

courses:	Cost *GST Incl.	Number Attending



FPQ offers some support in the area of language, literacy and numeracy. Please tick if you would like assistance with any of these areas.

paying by:
cheque	For $ encl.
invoice	Please invoice (Company order form should accompany this form) Order Number:
Credit Card	Visa Mastercard Bankcard
	Credit Card Number:	Expiry Date:
	Name on card:	Please debit: $
	Signature:________________________________________________________________
Version 2/2005

Version 2/2005