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Alan Roberts International Medical Graduates Support & Advisory Services

2015

ARIMGSAS Clinical Preparation Course - Application Form


Student Number:

STUDENT ENROLMENT INFORMATION 2015


STUDENT PERSONAL DETAILS
Given Name

AMC ID:

Family Name
Preferred Name
(if applicable)

Gender
(circle)

M/ F

Birth Date
dd-mm-yy

Email Address
Phone

Mobile

COURSE ENROLMENT DETAILS


Course Start Date
Location

Melbourne

ADDITIONAL INFORMATION
AMC Candidate ID:
AMC MCQ examination Score
Have you applied for AMC Clinical examination?

Yes:

No:

If so have you been given a place?

Yes:

No:

Exam Date:

RESIDENTIAL ADDRESS DETAILS


Address
Suburb

Post Code

State

Country

MAILING ADDRESS DETAILS Write AS ABOVE if the same as Residential Address


Address
State

Suburb

PAYMENT OPTIONS
1. PayPal

Online application form (1 % surcharge applies)

2. Bank Transfer

Contact us for bank details

3. Bank Cheque or Payable to Alan Roberts International Medical Graduates Support and Advisory Services P/L
Bank Drafts

4. In Person

EFTPOS Terminal

Note: Option 2, 3 & 4 have no surcharge


All Payments made to Alan Roberts IMGSAS. We do not accept American Express or Diners Club Cards.

Disclaimer:
*ARIMGSAS works in the best interest for IMGs and ARIMGSAS reserves the right to change the pricing for its courses as
required.

CLINICAL PREPARATION COURSE APPLICATION FORM


3 Bowen Cr, Melbourne, VIC 3004

PHONE
PH: +613 9867 3344
F: +613 8648 0605

EMAIL
admin@imgaustralia.net.au

WEB
www.imgaustralia.net.au

Alan Roberts International Medical Graduates Support & Advisory Services

2015

How to apply
Print the enrolment form provided above, complete
to admin@imgaustralia.net.au.

and send as email

attachment

Please provide a scanned copy of your passport size photo and your CV with your application form.

Application Processing and Closure

$ 1,000 will be deducted on application as deposit.


The remaining amount of $5,000 will be deducted automatically one month prior to the start
date.
Application for Clinical Preparation Course closes one week before the course starts.

Fees and refunds

ARIMGSAS Clinical preparation Course is priced at $6,000.00


$750 will be deducted if you withdraw from the course after application.
All fees must be paid in full one month before the course start date to confirm your place.
$1000 will be deducted if you withdraw less than two weeks prior to the start date.
Should you be unable to attend, a substitute participant is always welcome or you can postpone
your enrolment (subject to availability). Please inform us at least two weeks prior to start date
should you wish to substitute or postpone your place.
No refunds will be given once the course commences.

Payments
You can pay with Master card / Visa / Bank Cheque or Bank Draft / or direct deposit into Alan Roberts
IMGSAS bank account.

Enquiries
For all enquiries please email admin@imgaustralia.net.au or call us on +613 9367 3344.

Privacy Notice
ARIMGSAS collects personal information from you including your name, date of birth, and contact
details. We use this information to provide you with educational and other services requested by you.
We do not pass this information to third parties without your consent except where required or
authorised by law. You may access your personal information to determine what is being held and to
correct the information if it is found to be inaccurate by contacting us.

CLINICAL PREPARATION COURSE APPLICATION FORM


3 Bowen Cr, Melbourne, VIC 3004

PHONE
PH: +613 9867 3344
F: +613 8648 0605

EMAIL
admin@imgaustralia.net.au

WEB
www.imgaustralia.net.au