APPLICATION to enter SEAD COURSE 2008 Family Name Given Name Address for correspondence Telephone number Telexfax number Email address Nationality: Age: Sex: Qualifications (give details) TECHNICAL (Name of Degree) What is the broad technical discipline? (please tick whichever is appropriate): Mechanical Electrical/Electronics Chemical Biotechnical Other LEGAL   PATENT   Standard of English (please tick whichever is appropriate) ORAL:      very good          good          fair WRITTEN:   very good       good       fair Current Employment Details (give details) Employer's Name: Employer's Address: Previous Patent Courses attended Knowledge of Patent Law and how obtained (include length of time exposed to patents) Why course would be of value to you Name and Address of Sponsor (that is of the person responsible for payment of registration fees) Please return this form by 31 JANUARY 2008 to: Mr. David Carmichael Phillips Ormonde & Fitzpatrick Level 23. 367 Collins Street Melbourne, Victoria 3000 Australia Telephone: +61-3-9614 1944 Facsimile: +61-3-9614 1867 Email: david.carmichael@pof.com.au On acceptance to the Course, I 1. agree to attend both tutorial sessions and complete all of the set assignments 2. agree to pay the registration fees of US Dollars 2,500.00 3. understand that FICPI may at its sole discretion cancel my involvement in the course and return my registration fees. 4. agree to pay my travel and accommodation costs SIGNED ............................  DATE..................... (Do not send any money until you have been notified of acceptance to the Course).