Conversion to Audiometric Surveillance Registration Form

If you have any questions about or need assistance with completing this registration, please contact our Training Manager, Lynne Miles, on 1300 118 222 opt 1 or admin@hearingcompany.com.au.

After receiving your registration we will: update the information provided into the course register and send you the relevant accounts documents based on the payment method you select. Contact you or your company contact in line with the payment method selected.

This place will only be confirmed when full payment is received or a formal PO is received and accepted.

Participant Details

Surname/Family name*

Given name*

Preferred name

Job Title/Occupation*

Mobile Phone Number*

Email*

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

Course Date Selection

This is a 2-day course and attendance at all sessions is required (8:30am - 4:30pm).

Please tick your preferred date:*

Please let me know about future dates

Payment responsibility

The fee for this course is $2,150.00 ex GST ($ 2,365.00 including GST)

PLEASE NOTE: Payment in full or an agreed provision of a Purchase Order is required to secure a place on the course.

Please indicate who is responsible for payment of the course fees*

Company

Participant

Company details

Company Name*

Company Address*

Address Line 1 Address Line 2 City State / Territory Postcode Country

Company Contact Details (not participant)

Company contact name*

Company contact phone number*

Company contact job title*

Company contact Email*

Accounts Dept. Email*

Additional information we should be aware of

Additional details required for a private registration

Participant address*

Email for tax invoice/quote/receipt (if different to participant email)*

Additional information we should be aware of

Payment Method

Please select a preferred payment method*

EFT

Credit Card

Invoice/Quote/PO

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*

Invoice/Quote request

Please indicate if you require a quote or an invoice*

Quote

Invoice

Purchase Order has already been sent

Our Accounts Co-ordinator, Jeanette Cahalin, will send you a quote within the next 2 - 3 days.

If you have any accounts related questions, you can contact Jeanette on 0437 959 861 or office@hearingcompany.com.au.

Our Accounts Co-ordinator, Jeanette Cahalin, will send you an invoice within the next 2 - 3 days.

If you have any accounts related questions, you can contact Jeanette on 0437 959 861 or office@hearingcompany.com.au.

Please provide the purchase order number:*

If you have any accounts related questions, you can contact Jeanette on 0437 959 861 or office@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.

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.

THIS COMPLETES YOUR REGISTRATION - THANK YOU! PLEASE CLICK SUBMIT

Conversion to Audiometric Surveillance Workshop Registration Form

Participant Details

Course Date Selection

Payment responsibility

Payment Method

Cancellation/Transfer Policy

Confirmation and Course Information