Conversion to Audiometric Surveillance 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*

Dietary requirements (not required for in-company courses)*

Confirmation of graduation from past Audiometric Officer Course (Required for Certificate of Competence option.)

I confirm that the participant has successfully completed the Audiometric Officer Course and was registered with WorkCover WA on 31 March 2024.

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

Attendance at all sessions is required.

Please tick your preferred date:*

11 - 13 September 2024 (registrations close 29 August )
23 - 25 October 2024 (registrations close 10 October)
4 - 6 December 2024 (registrations close 21 November)

Please tick your session option:*

Certificate of Attendance - $1,320.00
Certificate of Competency - $2,145.00

Payment Details

The fees for this course are $1,950.00 ex GST ($ 2,145.00 including GST) for Certificate of Competence registrations.

The fees for this course are $1,200.00 ex GST ($ 1,320.00 including GST) for an Attendance Certificate registrations.

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/Quote

EFT Payment

Bank: ANZ

BSB: 016-350

Account: 429413238

Account Name: The Hearing Company Pty Ltd

(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 an email receipt within the next 2 - 3 days.

Total*

Price: $ 0.00

Credit card transactions incur a 1.8% surcharge.

Credit Card*

Authorisation*

I authorise The Hearing Company to process payment as selected above for registration into the Advanced Audiometry Surveillance course

Invoice or Quote

Please advise if your company requires a formal quote or invoice for generating a Purchase Order or to process payment through Accounts Department.

Please indicate if you require a quote or an invoice*

Quote
Invoice

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

Conversion to Audiometric Surveillance Workshop Registration Form