Order form

Interviews are available for purchase at AUD$15 each, including GST, postage and handling.

Print the order form and return it to the Academy.

Order form

Contact name:___________________________________________

School:_________________________________________________

Address:________________________________________________

_____________________________________Postcode:__________

Phone number:___________________________________________

Order no. (if required):_______________

Title	Qty	Price
__________________________________________	____	________
__________________________________________	____	________
__________________________________________	____	________
__________________________________________	____	________

Please tick the appropriate box:

___ Cheque enclosed

___ Mastercard     ___ Visa

___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___

Cardholder's name:__________________________________

Expiry date:___________ CCV:________ Signature:_____________________

Date:____________

Fax:	(02) 6201 9494
Post:	Australian Academy of Science GPO Box 783 Canberra ACT 2601