Workshop Application Form
Please note that all fields marked with an asterisk (*) are required.
* I am a:
Student
Parent
Teacher
Event Organiser
Other
* School / Event Name
Contact Details
* Contact Name:
Position:
* Phone:
Mobile:
Email:
* Address Line 1:
Address Line 2:
* City / Suburb:
* State:
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
* Postcode:
Visit Request Details
* Requested Date for Visit
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-
Month
01
02
03
04
05
06
07
08
09
10
11
12
-
Year
2009
2010
OR
Select a period
Month
January
February
March
April
May
June
July
August
September
October
November
December
-
Year
2009
2010
* Proposed Year Level
10
11
12
* Preferred visit structure
45 mins
60 mins
90 mins
Assembly
Time and length of the visit is negotiable, we are happy to try and accommodate your needs where possible.
Do you have any other questions or comments?
How did you find out about this programme?
Direct Mail
Television
Web Search
Previous Visit
Other Teacher / School
Other
How did you find out about this Website?
Direct Mail
Television
Websearch
Previous Visit
Other Teacher / School
Other
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