Application Form

Health Resource Training, Marriage Celebrants Australia Training and Development, and Biz IT Training Course Enrolment Form

PO BOX 196, Gordon 2072
Ph: 9440 3666 Fax: 9440 2988

To enrol in a course please forward completed enrolment form to:
Health Resource Training, Marriage Celebrants Australia Training and Development, or Biz IT Training,
PO Box 196,
Gordon 2072

FAMILY NAME: ......................................................................................................................

GIVEN NAME: .........................................................................................................................

Mr/Mrs/Miss/Ms/Other: .......................................................................................................

DATE OF BIRTH: ....................................................................................................................

TELEPHONE NUMBER: .........................................................................................................

GENDER:........Male........Female........ (Please Circle)

ADDRESS: .................................................................................................................................

SUBURB: ...................................................................................POSTCODE: .......................

COURSE NAME: .......................................................................................................................

COURSE DATE: ........................................................................................................................

ANY SPECIAL NEEDS? ........................................................................................................................

PAYMENT DETAILS: CASH CHEQUE MONEY ORDER

VISA MASTERCARD BANKCARD

CREDIT CARD NUMBER:

EXPIRY DATE: ........../..........

AMOUNT $ ............................

CARDHOLDER NAME: ...........................................................................................................

CARDHOLDER SIGNATURE: ...............................................................................................

The following conditions apply for all enrolments:

The specified non-refundable deposit must be sent with enrolment form to secure your place in the course.
Balance of Course Fee is payable on first day of course before the commencement of class.
You can assume that on receipt of your enrolment form and deposit you are enrolled in the class unless you are contacted by the College.
Receipts will be given on the first day of class.
No responsibility is taken for any of your personal property.
Fees cover tuition only unless specified.

SIGNATURE: .............................................................................................................................

PAYMENT DETAILS:	CASH	CHEQUE	MONEY ORDER
	VISA	MASTERCARD	BANKCARD

CREDIT CARD NUMBER:

	EXPIRY DATE: ........../..........
	AMOUNT $ ............................