TEACHER CODE

EXAMINATION ENROLMENT FORM

THIS FORM MAY BE PHOTOCOPIED FOR CONVENIENCE ABN: 37-882-817-280

Postal Address: PLEASE NOTE: WRITTEN AND PRACTICAL ENROLLER DETAILS: (ALL CORRESPONDENCE WILL BE SENT TO THE ADDRESS BELOW)
AMEB (WA)
The University of ENTRIES MUST GO ON SEPARATE FORMS! Title:___________ Name:________________________________________________________________
Western Australia Address:______________________________________________________________________________
M421, 35 Stirling Hwy, EXAMINATION REQUIRED:
Crawley WA 6009
________________________________________________________________ Postcode:____________

Australian Tel: (08) 6488 3059 WRITTEN 1

PRACTICAL Phone: (Home)_______________________________ (Mobile)__________________________________
amebwa@uwa.edu.au
ameb.uwa.edu.au Theory Metropolitan Email:________________________________________________________________________________
Music
Musicianship Country 1 Is this a change of address since your last entry?
Examinations Music Craft Diploma
Please indicate if enrolment submitted by:
Board (WA)
1
Preferred exam centre:_______________________________ School Private Teacher Self Entry (Name of Teacher:__________________________)

CANDIDATES: PLEASE REFER TO THE CURRENT EXAMINATION TIMETABLE FOR FEES, CHARGES AND ENROLMENT CONDITIONS.

Date of Birth Sex Surname Given Names Telephone Subject Grade Subject 2 N/O 3 Selected Fee Res S C
(M/F) (in order) Code Week $
Number

2
Where the subject is ‘for Leisure’, please add the words ‘for Leisure’.
3
Where a new (N) syllabus is available in parallel with an old (O) one, please indicate ‘N’ or ‘O’ in the column provided.
OFFICE USE ONLY
Receipt No.
DECLARATION:

UniPrint 157382_AMEB
I accept all AMEB policies relating to the conduct of Signature:________________________________________________________________________
examinations as outlined in the current Manuals of (THIS ENROLMENT WILL NOT BE ACCEPTED UNLESS SIGNED)
Syllabuses. I also accept all AMEB(WA) policies relating to
cancellations, withdrawals and transfers, as outlined on the Date:_________________________
State web site and current AMEB Examination Timetable.

PLEASE LEAVE BLANK IF EMAILING. PHONE YOUR CREDIT CARD DETAILS THROUGH TO AMEB OFFICE.

TOTAL FEE ENCLOSED: $__________________ CREDIT CARD INFORMATION:

FORM OF PAYMENT:
Cash Cheque* Credit card
*Please make cheque payable to UWA
Card type: VISA Mastercard Card No: Expiry: Amount: $
Name:_________________________________________________________________________ Signature:___________________________________________________
Address:___________________________________________________________________________________________________________Postcode:_______________