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: 6 - 27 March, 24 April - 5 June, 19 June and 17 - 24 July
Location: School of Chemistry, University of Melbourne
Cost: $300.00 (no GST)

Enquiries: mmoylan@unimelb.edu.au or (03) 8344 6465

First Name
Your answer
Last Name
Your answer
Student's email address
Your answer
Please re-enter the student's email address to confirm.
Your answer
Student's Postal Address
Please include number, street name, suburb and postcode.
Your answer
Student's Phone Number
Your answer
Parent/Guardian's Full Name
Your answer
Parent/Guardian Phone Number
Your answer
School and Campus
Your answer
Year Level
Your answer
School Telephone Number
Your answer
Chemistry Teacher's Name
Your answer
Chemistry Teacher's Email Address
Your answer
Payment
Direct Deposit (preferred) to
Account Name: Chemistry Education Association,
BSB: 083-230,
Account Number: 515611011
with 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
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms