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"When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has been opened for us."
Helen Keller
OPA Membership Registration Form
Please register me for membership into the OPA
Fields marked with an
*
are required
*
please select
Opening special - free membership option for limited time only
*
Title:
Mr.
Mrs.
Ms.
Dr.
Miss
*
First Name:
*
Last Name:
*
Job Title:
*
Company:
*
Email:
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Postal Address:
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Suburb/Town:
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State:
- Please Select -
WA
NSW
VIC
QLD
SA
TAS
ACT
NT
Other
*
Post Code:
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Phone:
Fax:
Please recommend a colleague who may be interested this free membership offer!
Name:
Job Title:
Company:
Phone Number:
Who is your direct report in your company?
Name
Job Title:
*
How did you hear about the OPA?
- Please Select -
OPA Brochure
Through the 2005 OPA competition
Colleague
Brochure
OPA Event
Email
Website
Fax
Customer Service
Other
If other please specify:
Company Size:
- Please Select -
1-49
50-249
500-999
999+
Industry:
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Public Sector
Financial
Retailing
Distribution
Services
Technology
Construction
Oil & Gas/Chemical
Utilites
Manufacturing
Other
If other please specify:
Payment Method
-
Not applicable for Opening special - free membership option for limited time only ( Please do not enter any details below)
1.
Company Cheque, or
2.
EFT - Remit to IIR Pty Ltd BSB: 062-217 Account: 0027 7915 with the Commonwealth Bank
Expected date of transfer
and EFT transfer No.
3.
Credit Card - Type of credit card:
- Please Select -
Visa
Master Card
AMEX
Diners Club
Credit card number:
Card Holder's Name:
Expiry Date:
/
(mm/yy) with the sum of: $
*
A credit card fee of 1% will apply for payments made by AMEX or Diners
Privacy Clause: The above information is being collected by
the
OPA, a division
of IIR Pty Ltd. It will be added to our delegate database and will be used primarily to provide you with further information about OPA events and services. From time to time the OPA may share personal information from our delegate database with other professional training organisation promoting similar products and services. Please tick the box below if you do NOT want us to disclose the information. You may also access this information, or have it corrected or updated. If you wish to lodge a complaint about the handling of your personal information or do not want us to keep you on our database, please contact our Data Integrity Division on +61 (0) 2 9080 4085.
*
I have read the privacy clause & accepted the terms & conditions related to this membership registration
I do not wish to have my details made available to other organisations
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