Australian Directory of Music & Speech Teachers

www.musicteachers.com.au - ABN 79 794 493 065

APPLICATION FOR REGISTRATION - TAX INVOICE -

Please note:

Only teachers who hold a Degree, Diploma or Certificate in Music or Speech issued by a University or Tertiary Institution, are eligible to register for listing with the Australian Directory of Music & Speech Teachers - minimum qualification level is Associate Diploma ( i.e. A.T.C.L. , A.Mus.A. , A.D.M.T. etc.) in each instrument you wish to list with the Directory.

For registration, please return the form below by post along with photocopies of the qualifications for each instrument that you wish to have listed. Please note: copies must be certified by a Justice of the Peace.

Name : _______________________________ Instrument / s__________________________________

Address : ______________________________________________________ Postcode ____________

Phone_________________ Fax ____________________ Email ________________________________

Qualifications held : ___________________________________________________________________

______________________________________________________________________________________

I the applicant certify that the above information is true and correct and acknowledge the following :

• that I authorise the Australian Directory of Music & Speech Teachers to seek information from Tertiary Institutions / Conservatoriums / Examination Boards for the purpose of verifying my professional qualifications should this be deemed necessary.

• that I shall have no right of action against the Australian Directory of Music & Speech Teachers, its employees, officers and agents in any event arising from this application.

• that I indemnify the Australian Directory of Music & Speech Teachers, its employees, officers and agents against all claims for any direct or indirect loss or damage (howsoever caused) which may be suffered by any person subsequent to or as a result of the publication of my professional details on the web site www.musicteachers.com.au or in any printed material produced by the Australian Directory of Music & Speech Teachers.

Signature ___________________________________ Date ______________________

Registration Valid - 1st July 2008 / 1st July 2009 - Annual Fee : $148.50 + One off Internet set-up fee $27.50 = TOTAL $176.00 incl. GST

PAYMENT DETAILS : I enclose a cheque for $176 payable to the Australian Directory of Music & Speech Teachers or please charge my VISA / MASTERCARD $176.00 for 2008 / 2009 Registration with the Directory

No. ___________________________________________________________

Expiry Date : ____/____ Signature ____________________________________

Mail or fax to :

Australian Directory of Music & Speech Teachers

P.O. Box 101, Croydon NSW 2132

Fax : 02 9744 9233