AMEB SA & NT Prize Acceptance Form

To submit this form, you must be 18 years old or older. If the candidate selected for the prize is under 18, then the form must be submitted by a parent or guardian on their behalf.

Prize recipient's details

This is the candidate named as the prize recipient in the prize notification email.

University student ID (if applicable)

Title

Given name

Family name

Postal address

Prize details

Prize name

Prize value: $700

Prize value: $2800

Prize value: $2700

Prize value: $650

Prize value: $500

Prize value: $1000

Prize value: As advised

Prize value: $50

Prize value: $250

Prize value: $100

Prize value: $50

Prize value: $220 per year (tenable for 3 years)

Prize value: $220 per year (tenable for 2 years)

What instrument and grade does this prize relate to (if applicable)?

I wish to accept the above-named prize/award which has been offered by AMEB SA & NT.

My details

Please check the applicable box below

I am the prize recipient/candidate

I am submitting on behalf of the candidate

Relationship to the candidate

My name

Email address

Mobile phone number

My bank account details

Australian Domestic Deposit accounts only – please contact AMEB if you have an international account.

Bank name

BSB number

Bank account number

Name of account holder

I hereby give The University of Adelaide authority to credit all monies due to me to the account specified directly above. This authority remains in effect until cancelled in writing.

Signature

Sign above

Important: Please note that if the prize is funded by the University (and not an external organisation) the payment of the prize can take up to 8 weeks unless the candidate is already a student at the University. This is provided the details above are correct.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.