Online Registration Form

Your Details:
Title*	Mr	Ms	Other
Given Name*				Family Name*
Date of Birth*	/ /			Gender*	Male	Female
Address*				Telephone*
					(Home)
					(Work)
					(Mobile)
					(Fax)
Email*

Special Requirements:

Do you have special dietary requirements ?*

Yes

If YES, they are :

Do you suffer from any know illness or allergy ?*

Yes

If YES, they are :

Other Information:

How did you first learn about Life Skills Hospitality group? (You can tick more than one) *

Friend or Co-worker

Magazine Advertisement (please specify below)

Newspaper Advertisement (please specify below)

Google, Yahoo or another Search Engine (please specify below)

Seminar

Other (please specify)

Payment to be made by either of the following:
Select how you will be paying (Tick the box below) *
	a) Money Order or Cheque. Please make payable to "Life Skills Hospitality Group"
	Post to: P.O Box 6727, EAST PERTH, Western Australia 6892 \| ABN 71 701 260 727 \|
	b) Direct Deposit to: "Life Skills Hospitality Group"
	BSB: 066-110 Account Number 10146313 \| Commonwealth Bank of Australia \|

Declaration of Terms and Conditions:

I/We declare that the information I/We provided on this form is true and complete in every detail. I/We have read and fully understand the Terms and Conditions of the enrolment through Life Skills Hospitality Group, included as part of the Application Form.

* I have read and understand the Terms and Conditions. * DATE: / /

Indemnity: (only if you have a guardian or carer)
I, the undersigned guardian/carer (insert your name) * do hereby give permission for following _____(insert participant's name) * to attend and participate in organised Life Skills Hospitality Group classes, and whilst I am aware that Life Skills Hospitality Group and its staff will take every precaution to ensure the safety of the above named participant, I agree to waive any rights to claim any damage or compensate from Life Skills Hospitality Group or any of its employees for any loss or injuries sustained by or to the above named participant as a result of participating in such Life Skills Hospitality Group class(s).

* I, guardian/carer of the above named participant have agreed with the information above and I understand the Terms and Conditions. DATE: / /*

Privacy | Copyright | Disclaimer