Chemistry Olympiad Training Program - Registration Form
Length of training program: 2 hours per week for 14 weeks
Time: 5.30 - 7.30 pm, Monday evenings
Dates: 5, 19, 26 March, 16 April - 4 June, 18 June and 16 - 23 July
Location: University of Melbourne
Cost: $310.00 (no GST)

Enquiries: or (03) 8344 6465

First Name *
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Last Name *
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Preferred name (if different to first name)
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Student's email address *
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Please re-enter the student's email address to confirm. *
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Student's Postal Address *
Please include number, street name, suburb and postcode.
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Student's Phone Number *
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Parent/Guardian's Full Name *
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Parent/Guardian Phone Number *
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School and Campus *
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Year Level *
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School Telephone Number *
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Chemistry Teacher's Name *
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Chemistry Teacher's Email Address *
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Direct Deposit (preferred) to
Account Name: Chemistry Education Association,
BSB: 083-230,
Account Number: 515611011
use the student's last name as the payment reference.

Cheque payments should be made out to Chemistry Education Association, and posted to
PO Box 4142, The University of Melbourne, Parkville 3052.

Payment must be made before attending the first lecture.

Payment Method *
I have my parent/guardian's permission to attend this training program *
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