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Workshop Registration Form
Workshop:
Student Details
Family name:
Given name:
Gender: Male
Female
DOB: / /
Swim School:
Experience:
CPR Qualified: Yes
No
Austswim No:
Ascta No:
Other swim qualifications:
Special needs:
Contact Details
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Work Phone:
Mobile:
Fax:
Email:
Address:
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Payment Details
Select Workshop: 4hr Professional Development Workshop $58
Instructors Professional Development Workshop $380
One Day Professional Development Workshop $210
How will you pay?: PayPal - Pay by credit card
Cheque
Direct Deposit
Who do we invoice?:
Promotional code:
Payment is due 7 days prior to commencement of course date
$20 Late Fee applies for payment inside 7 days

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