MRFEC Registration Form 2008

NO REFUNDS
Please check your enrolment carefuly. Except as required by the Trade Practices Act, we regret that a refund will only be given if a class does not proceed.

This registration form can be completed on-screen then printed, or printed blank then completed by hand.

Date:   

Course Code

Fee

Concession

Employment Category
Full time employee
Part time employee
Self employed
Employer
Employed    
Unpaid family worker
Unemployed    
- Seeking Part-time work
Unemployed    
- Seeking full-time work
Not employed    
- not seeking employment

I am paying the amount of $

Cash

Cheque

Credit Card

Are you eligible for aConcession ?

Family Allowance / Parenting Single

Mature Age / Newstart / Youth Allowance

Age / Carers Disabilty Support

Sickness Allowance

Other

Low Income

Concession Type:

Concession No:

Do you consider yourself to have a disability,
impairment or long-term condition
 ?

Yes No
Physical Intellectual Visual Chronic Illness
Hearing Mental Illness Acquired     
Brain Impairment
Medical     
Condition

Name and Address Information

Surname

FirstName

Title

Address

Postcode

Phone (H)

Phone(B)

Sex M F

Date of Birth

Country of Birth

Ages of children requiring childcare (under5)

Do you speak a language other than English at home ?
Yes No
How well do you speak English?
Very Well Well Not Well Not at all
Are you of Aboriginal or
Torres Strait Islander origin ?
No Yes Aboriginal Yes Torres St Is
What is your highest level of Secondary Schooling completed ? (Please select one)
Year 12 Year 11 Year 10 Year 9 Year 8
or below
Year
Completed
Since leaving school have you completed a qualification ?
If yes, please select one of the following
Bachelor Degree or Higher Degree Advanced Diploma or Associate Diploma
Diploma Certificate IV or (Advanced Certificate)
Certificate III (or Trade) Certificate II
Certificate I Other Certificate
Of the following categories, which BEST describes your reasons for undertaking this course. (Select one)
To get a job I want exta skills for my job
To develop my existing business To get into another course of study
To start my own business For personal interest
To try for a different career For self development
To get a better job or promotion Other Reasons
It was a requirement for my job  

Credit Card Details

Bankcard/Visa/Mastercard

Expiry Date

/

CardHolder Name

Signature

This form can be printed using

  • the icon in the toolbar at the top of your screen, or
  • the Menu command File...Print

Please send completed forms to: 

MRFEC, P.O. Box 68,
Gisborne 3437

Or Fax to 5428 3278