PilchConnect Seminar Registration Form

If you wish to register please complete the form below.

PilchConnect Seminar registration form

Seminar details Please choose the seminar that you wish to attend. Note that this seminar series is only for not-for-profit organisations.
Seminar Name
Contact persons' details Please provide us with the details of the person who is making the registration
* Full name
* Position
* Contact e-mail address
* Direct phone number
PilchConnect mailing list	Please let us know if you wish to be added to our mailing list
Organisation contact information Please provide us with the contact details for your organisation
* Organisation full name
* Street address
* Suburb/Town
* State
* Post-code
Postal address	If different from street address
General e-mail
Website
Phone
Fax
Names of those attending A maximum of 2 people per organisation.
* 1
2
Questions	Our questions are... Please set out any general questions you would like the presenter to consider
Special requirements	Please let us know if there are any special requirements you need to assist with you participation in this seminar
* How did you hear about PilchConnect?
Please specify	If you chose 'Other' please specify
Organisation Details Please complete to enable us to better tailor the presentation to the needs of your organisation as a whole.
* Organisation Type	Please tell us the legal structure of your organisation
Please specify	If you chose 'Other' for organisation type please specify
* Taxation status	Income tax exempt charity (ITEC) Public benevolent institution (PBI) Deductible gift recipient (DGR) None of the above
* Principal Activity	Hold down the 'Control' ('Ctrl') key if you wish to select more than one
Please specify	If you chose 'Other' for principal activity please specify
* Primary purpose	Serve members/supporters Serve public
* Geographic area	International National Victoria Local (please specify) Please choose only ONE.
Please specify	In the above question if you chose 'local' for geographic area please specifiy, eg. western region
* Number of employees (EFT)	none up to 10 10 - 100 100 - 1,000 over 1,000
* Number of volunteers	none up to 10 10 - 100 100 - 1,000 over 1,000
* Number of individual members/member organisations	none up to 10 10 - 100 100 - 1,000 over 1,000
* Annual income from all sources	up to $1,000 $1,000 - $100,000 $100,000 - $1million $1 million - $5 million over $5 million eg. membership fees, grants, fee-for-service