REGISTRATION FORM STEP 1 - REGISTRATION DETAILS

Please read each section AFAS

carefully. Should you have any
questions, please contact your Course Name
Trainer/Assessor for additional To be Confiormed
information. Please ensure you
have completed this registration Course Commencement Date
form in full.

Terms of Engagement Please Tick  Mr  Mrs  Ms  Miss  Other ______________

I understand that payment for all Bagaconza

courses (fees) is required in full Surname
on return of this registration form Benson Jr
and/or prior to commencing the
course. Given Names (As you would like shown on your certificate)
26 Corring Way Parmelia 6157
Upon receipt of payment, I will
be supplied with the course Address Post Code
materials. Should payment in
advance not be possible then I Is this Licence  Provisional  Full
agree to pay the fees to Pest Pest Control Licence No (If issued)
75
Education Services & Training Phil O'Keeffe
within fourteen (14) days of Mentor Pest Control Licence No
receiving an invoice.
In the event that I fail to pay any
invoice within fourteen (14) days STEP 2 - PAYMENT DETAILS
of the date of the invoice, I
agree to pay Pest Education Paid already by Fume West
Services & Training interest at Company (Only if your company is paying for training)
the rate of 15% per annum on all
overdue sums by way of P.O. Box 8035 Hilton WA 6163
compensation. Address (if same as above, write “as above”) Post Code
In the event that Pest Education
Services & Training must Home Telephone Work Telephone
engage a debt collector to
retrieve fees, I agree to pay all 0437987687
collection costs of and incidental Mobile Facsimile
to the collection, including all phil@fumewest.com
solicitors’ costs and associated
court fees and charges. Email
$1,194.00 EFT
Refund Policy
Payment Amount Due Payment by Cash, Cheque or Electronic funds
Clients have fourteen (14) days Transfer (EFT) is accepted
from the receipt of registration
and payment to apply for a
refund. Applications must be STEP 3 – CONDITIONS OF REGISTRATION
made in writing stating the
reasons for terminating the Please initial each box below to confirm that you have received, read or had explained
course. A full refund will apply and agree to the conditions of registration listed.
to course materials if these are
returned in the exact condition 1. I have read and agree to the terms of engagement …………………..……................... 
they were provided. No refund
will be granted for materials that 2. I have read and agree to the refund policy……............................................................. 
are damaged or marked. Only a
portion of your training and 3. Payment for this course is required upon registration. If payment in advance is not
assessment fees will be possible please contact Mark Sheppard on 9443 3733 to authorise an alternative.
refunded. This amount will be
determined once the hourly rate
of $180 plus GST is deducted
for all work undertaken on your
behalf. No refunds will be 19/12/2023
granted once a course has
Signed Date
commenced.

Form C4-3b Version: 6/2006 Date Issued: August 2006 Page 1