[share-ebook]Chemical Engineering Experience I would like to accept the offer to participate in Chemical Engineering Experience program


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Chemical Engineering Experience:

A Two-Day School Holiday Program

STUDENT ACCEPTANCE FORM - 2008

 

Student Surname  
Student Given Names  

 
 

Medical Information

Medicare Number  

 

Private Cover?
Yes
        No    
Fund Name  
Fund Number  
Emergency Contact Information (Please give at least two different contacts)

Parents/Guardians Contact 1 Contact 2

Name    
Relationship    
Telephone (Work)    
Telephone (Home)    
Fax    
Mobile    
Email    

Other contact person  Contact 3 Contact 4

Name    
Relationship    
Telephone (Work)    
Telephone (Home)    
Fax    
Mobile    
Email    

 
 

I would like to accept the offer to participate in Chemical Engineering Experience program.  I agree that by accepting this offer I will be bound by and observe the following conditions:

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