Course Registration Form

Training Application Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student E-mail
Mobile Number

Area CodePhone Number
Phone Number

Area CodePhone Number
Work Number

Area CodePhone Number
Employment or Business Information

Street Address

Post code
Instagram
Username
Website
Business website
What is your occupation?
Qualifications
Do you have professional indemnity insurance?
Company or Broker
How did you hear about Cosmetic Wellness?
eg. Google friend instagram
Payment Details

By direct debit or credit card authorisation
COSMETIC WELLNESS PTY LTD

ACN 633 405 017

Bank Details for Direct Debit

Commonwealth Bank
Cosmetic Wellness
BSB 062235
Account 10907540
A minimum deposit of $2000 training fee will need to be paid to secure your place in the training, once you have completed this registration form you please transfer to the above account. AfterPay available for part payments. Full balance of workshop fees of $5000+GST must be paid 7 days prior to commencement date. The deposit is strictly non-refundable, payment of your deposit is acceptance to these terms & conditions
Date
Signature
Should be Empty:

Training Application Form