InstyleSwimming Australia - Online Registration

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
Home phone:
Work Phone:
Mobile:
Fax:
Email:
Address:
Suburb:
State:
Postcode:
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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