Membership Payment Form

Please fax completed form to the Talent2 User Group Secretariat on +61 7 3378 9513

Payment Type:

Contact Name:

Organisation:

Organisation Address:

Email:

Phone Number:

Please enter any notes or comments below

Payment Type

EFT (details listed below)
Cheque (payable to Talent2 User Group Inc)

(If no payment type is identified Talent2 User Group will invoice the attendee organisations above)

EFT Details
Bank Name: Bank of Queensland, Kenmore
Account Name: Talent2 User Group Inc
BSB No: 124 103
Account No: 20415462

Credit Card Details
Payment authorisation for Talent2 User Group to charge the following card:

Payment Amount:
Card Type:
   
Name on Card:
Card Number:
Expiry Date:

Signed:

 

_______________________________________