Audiometric Surveillance Workshop Registration Form

For assistance with completing your registration, please our Course Manager, Lynne Miles, on 0478 776 039 or admin@hearingcompany.com.au.

Participant Details

Surname/Family name*

Given name*

Preferred name

Title

Job Title/Occupation*

Mobile Phone Number*

Email*

Registration Type

Please indicate if this is a company or private registration*

Company registration
Private registration

Company & Manager Details

Company Name*

Primary Contact*

Job Title*

Company address*

Contact phone number*

Primary contact email*

Additional information we should be aware of

Session Selection

This course has the option of attending session 1 only or attending both session 1 and a practical session 2. Attendance at the full session is required. Please tick your preferred option.*

Please tick your preferred date/session option:*

6 November 2020 (Perth)
I wish to discuss the option of a customised, on-site delivery of this course

Payment Details

The fees for this course are:

Perth - $ 770.00 including GST

PLEASE NOTE: Payment in full is required to secure a place on the course.

Want to send the invoice/receipt to a different email?*

No
Yes

Email for tax invoice/receipt*

Payment method*

EFT
Credit Card
Invoice/Purchase Order

EFT Payment

Bank: JB Were Cash Trust (NAB)

BSB: 083-973

Account: 000633185

Account Name: The Hearing Company

(N.B. Cash deposits cannot be accepted)

Once the EFT payment has been successfully processed, please send the transaction evidence to admin@hearingcompany.com.au clearly stating the Company name and name of student that the payment relates to.

Our staff will then process the registration and send formal confirmation within 2 - 3 days.

Credit Card Payment

Please provide card details below.

Our staff will process payment within the next 2 - 3 days and email a receipt.

Card Type*

Visa
Mastercard

Name on Card*

Card Number*

Expiry Date*

Authorisation*

I authorise The Hearing Company to process payment as selected above for registration into the Audiometric Surveillance Workshop

Invoice/Purchase Order

If your company requires a formal quote or invoice for generating a Purchase Order or to process payment through Accounts Department, please contact Lynne Miles on 0478 776 039 or admin@hearingcompany.com.au.

Cancellation/Transfer Policy

The following fees are payable should a participant withdraw from the course:

Following registration: 10% of the full fee

Within 2 weeks of the starting date: 50% of the full fee

Within 1 week of the starting date: 100% of the full fee

PLEASE NOTE:

1. A registration may be transferred to another person within the same course at no additional charge.

2. We do not offer "transfers" to another course. Withdrawal from a course after confirmation of registration will be treated as a cancellation and subject to the cancellation fees outlined above.

Cancellation Policy Agreement*

I confirm that I have read, understood and agree to the Cancellation/Transfer Policy as outlined above.

Confirmation and Course Information

Following registration, formal confirmation and a tax invoice/receipt will be emailed within 2-3 working days. Please contact the Course Manager, Lynne Miles on 0478 776 039 or admin@hearingcompany.com.au if you do not receive a confirmation email.

The confirmation email will contain information about the arrangements and an outline of what to expect during the course.

Audiometry Practice Support

For reference, The Hearing Company specialises in supporting audiometry practices with a range of quality services and products including:

> Audiometric booth assessments

> Audiometer sales

> Audiometric booth sales

> Audiometry program auditing and advice

> Audiometry accessories

> Full Audiological testing

Please contact Glenn Johnson on 0414 452 007 or glenn@hearingcompany.com.au to discuss your requirement for support in any of the areas outlined above.

THIS COMPLETES YOUR REGISTRATION - THANK YOU! PLEASE CLICK SUBMIT