2012 electronic enrolment form

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					                                                                                                            HAVE YOU (The Enroller/Teacher) CHANGED YOUR                          ENROLLER (Teacher)
      2012 Enrolment Form - Music, Speech and Theory Examinations                                           ADDRESS / EMAIL / PHONE NO?                                           NUMBER

                   Australian Music Examinations Board                                                      ENROLLER DETAILS
                              9 Nathan Ave, PO Box 21, Ashgrove 4060                                        Title
                                        ABN: 76 337 613 647                                                 Surname
                    Phone 07 3514 4333 - Fax 07 3514 4300 - Toll Free 1800 175 515                          Given Names
                          Email: payments.ameb@dete.qld.gov.au                                              Address [Line 1]
                                                                                                            Address [Line 2]
               OFFICE USE ONLY                     Session for Examination                                  Suburb

Doc. No.:                                                                                                   State                           P/Code                                H/Phone

Session No.:                                       Requested Centre for Examination                         Email                                                                 W/Phone

Centre No.:                                                                                                 Signature                                                             Mobile

      FULL PAYMENT OF FEES TO ACCOMPANY THIS FORM : Payment Options - Credit Card- (Mastercard/Visa only), EFTPOS, Cash, Cheque, Money Order
                                                                                                                QCE (Years 10, 11, 12)
                                                                                                                                 Year of
 Candidate                                                                                         Gender                    Registration Year 12      Date of Birth    Subject
  Number                    Surname                               Given Names                       M/F        LUI Number      (in Yr 10)  Y/N         (mandatory)       Code               Subject               Grade        Fee ($)

                                                                                                                                                                                  No Subject                n/a              $0.00


                                                                                                                                                                                  No Subject                n/a              $0.00


                                                                                                                                                                                  No Subject                n/a              $0.00


                                                                                                                                                                                  No Subject                n/a              $0.00


                                                                                                                                                                                  No Subject                n/a              $0.00


                                                                                                                                                                                  LATE FEE


Please list any candidates with disabilities, impairments and or special needs (please provide supporting documentation with enrolment)                                           TOTAL AMOUNT DUE:                          $0.00




As a guide for scheduling examinations, please advise any days, or dates that candidate/s are NOT AVAILABLE, eg School Camps, Religious Observances etc. While every consideration is given, it may not be possible to meet all
needs.



This entry form will be received on the understanding that the teacher and candidate/s are aware of and accept the regulations and important information published in the current AMEB Manual of Syllabuses and on AMEB (Qld) website.
Candidates will be scheduled (wherever possible) in the order that they have been nominated.
** Note: Any student in Year 12 who requires their AMEB results to be recorded on their QCE Statement must be examined by 31 October. Refer to AMEB (Qld) website for information on the Queensland Certificate of Education.


                                                                                                                                                                           Total amount payable:                       $0.00
                                                                                                                                                                       For payment by credit card refer page two

                                                                                                                                                                         OFFICE USE ONLY ____ / ____ / ____ (Initials) _________
CREDIT CARD PAYMENT
PAYMENT TO:            Australian Music Examinations Board (QLD), ABN 76 337 613 647
                       PO Box 21 Ashgrove, QLD 4060


PAYMENT FROM:                Enroller (Teacher) ID



CREDIT CARD HOLDER'S                 Name:
DETAILS
                                    Address:

                                                                                       Postcode:

                                    Phone:


PAYMENT DETAILS:             Please debit my credit card for the amount of:   $


CARD NUMBER:
Mastercard/Visa only

EXPIRY DATE:


NAME ON CARD:


DATE:

				
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