AEAS - 2025 - SEPTEMBER - CAMBODIA - Agent Workshop Registration Form

Agency Details

Agency Trading Name*

Agency Address*

Street Address Address Line 2 City / Suburb State / Province / Region ZIP / Postal Code Country

Agency website*

Agency Phone Number*

Please include your country's dialling code - e.g. +855 1234 5678

Agency Main Contact for Australian Schools

Title*

Please select the appropriate title

Other (please specify)

First Name*

Last Name*

Job Title*

Email Address*

Enter Email Confirm Email

Phone number*

Please include your country's dialling code - e.g. +855 1234 5678

Participant Details

How many staff members from your agency will participate in the Agent Workshop?*

Staff Member 1

Please provide the personal particulars for Staff Member 1

Title

Please select the appropriate title

Name*

First Last

Preferred English name

If applicable

Job Title*

Email*

Enter Email Confirm Email

Mobile Phone*

Please include your country's dialling code - e.g. +855 1234 5678

Dietary Requirements*

YES

NO

Dietary Requirements - Details

Please provide details of your dietary requirements so that we may cater for you accordingly.

Staff Member 2

Please provide contact information for Staff Member 2

Title

Please select the appropriate title

Name*

First Last

Preferred English name

If applicable

Job Title*

Email*

Enter Email Confirm Email

Mobile Phone*

Please include your country's dialling code - e.g. +855 1234 5678

Dietary Requirements*

YES

NO

Dietary Requirements - Details

Please provide details of your dietary requirements so that we may cater for you accordingly.

AEAS Events for Education Agents

Australian Schools – Education Agent Workshop

PHNOM PENH, CAMBODIA

Agency Details

Agency Main Contact for Australian Schools

Tell us a little about your agency

Is your agency active in the Australian schools market?

Agency marketing

Social Media

Participant Details

Staff Member 1

Staff Member 2