QCWT Registration Form Gateway Schools PD Tour April 2016 .pdf

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P R O G R A M
A P P L I C A T I O N F O R M
G A T E W A Y T E A C H E R

P D

Please return completed form to
Jules.mcmurtrie@usq.edu.au

Privacy Statement
This form is to gather information about you and to validate your participation in this limited program
offered by the Gateway Schools Network. We will use this information for program administrative purposes
such as issuing certificates of attendance. Information on this form will remain securely stored at QCWT
and will not be made available to any third party. Completion of this form does not mean your application
has been successful. Please Note the following important dates & conditions:
 Applications close Friday 4 March, 2016
 Notifications of successful admission to PD tour immediately upon registration or by
11 March
 Gateway Schools receive priority
 RTO trainers are invited to attend only through school partner inclusion
Title:

 Mr

 Mrs

 Ms

 Other

First Name

___________________________________________________________________

Last Name

___________________________________________________________________

Date of Birth
_____/_____/_____
(Required as evidence that you are legally old enough to taste wines and required for security purposes)
School/Organisation ___________________________________________________________________
School Associated if RTO application: ______________________________________________________
PLEASE NOTE: RTO APPLICATIONS MUST BE ACCOMPANIED BY A SCHOOL REP
Phone

____________________________ Mobile ________________________________

Email

___________________________________________________________________

Special Needs/dietary requirements ________________________________________________________
Emergency Contact

____________________________ Phone ________________________________

Signature

____________________________ Date _________________________________

Payment Details
For Individuals - Payment required with order Cheque/Credit Card by 24 March 2016. Invoice is available.
Cheque/Money Order Please make cheques payable to ‘Queensland College of Wine Tourism’ (USQ A.B.N. 40 234 732 081) Credit card – Please complete the payment form below.
Card type (please tick)  VISA
 MASTERCARD
 BANKCARD
Name on Card

___________________________________________________________________

Card No

___________________________________________________________________

Expiry Date:

Month__________Year _________ Amount: $ ______________________________

Signature

____________________________ Date __________________________________

Course Details

Friday 8 April 2016—8.45am for a 9am departure
Yes, I will be at the Brisbane Convention Centre - Glenelg St entrance for a 9am
departure and understand we return 3pm on Monday 11/04 to this location (see
BCEC Map).

FREE

FULL DAY Friday 8/4 including coach transfer to Stanthorpe, wholesale distributor
tour at Fino Food and Wine, lunch @ Royal International Convention Centre,
Cicada Indigenous Tour, Free Range Chicken Farm Tour and a Brewery Tour &
Brewers Platter Degustation @ Happy Valley Retreat & Granite Belt Brewery.
ACCOMMODATION OPTIONS INCLUDE: Happy Valley Retreat B&B inclusive $505 - 3 days twin OR
single share see: www.happyvalleyretreat.com.au or call (07) 4681 1370 and quote GATEWAY to receive
this special price OR Top of the Town Caravan Park has a selection of budget accommodation available
from $55 per night/twin share see: www.topoftown.com.au or ph (07) 4681 4888. **PLEASE NOTE: coach
pickups and drop offs will be to these two accommodation providers unless otherwise arranged.

Saturday 9 April 2016—8am start—9pm
FULL DAY Sat 9/4 including coach transfers, Law Dogs Show, Australian Vinegar tour,
Strawberry fields coffee & strawberries, Golden Grove tasting, lunch @ Barrel Room,
Chef talk, Jamworks, Jester Hill sunset tasting & regional, seasonal dinner.

Sunday 10 April 2016—8am start—9pm
FULL DAY Sun 10/4 including coach transfers, Kalei Apple Tour, Suttons Farm coffee, packing shed, Cheese Maker Visit, QCWT Cooking Demo, Medley of Mains
with matching local wines, facilities tour, interactive canapes & entertainment.

Monday 11 April 2016
Using Cookery Skills in Industry Hands On Workshop w Matt Golinski @ $125
Wine Chemistry Masterclass w Peter Orr @ $60
Front of House Masterclass w Kim Gallaway @ $60
Lunch with Matt Golinski & transfers @ $80
YES! I will register myself on the Fine Food Queensland website for FREE entry
http://www.finefoodqueensland.com.au/ from 3-5pm on Monday and/or 10-3pm Tues
YES! I understand I will be dropped back to the Southbank Convention Centre at
3pm on Monday 11 April at Glenelg St entrance.

TOTAL

$

To charge to:
Please note: Self Drive = Same price. Coach accommodation pick ups daily include: Happy Valley Retreat and Top of the Town
Caravan Park. Alternatives will have to be on arrangement, please contact Jules direct. Payment and forms must be in March 11.
RTO applications will only be accepted if accompanied by a Gateway school representative.

Phone 07 4685 5014 or 0419 709 160
Email completed form to
jules.mcmurtrie@usq.edu.au

qcwt.com.au | varias.com.au


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