Register Which course are you registering for?*Choose a CourseRopes Crossing, NSW - May2017Wagga, NSW - May 2017Hughsdale, VIC - May, June 2017Name* First Last Age*15-2425-3435-4445-5455-6465+Is your partner attending? YesPartner's Name First Last Partner's Age*15-2425-3435-4445-5455-6465+Residential Address* Street Address Address Line 2 City State Post Code This is also my postal address*YesNoPostal Address Street Address Address Line 2 City State Post Code MobileLandlineEmail* How did you hear about the course?*Ages of Children/Grandchildren*Knowing the ages of children in your care helps us to tailor the course to suit this age group. Course Fees (select which applies to you)*Individual - $80Couple - $110Individual (concession) - $50Couple (concession) - $80Total $ 0.00 Payment*I'd like to pay via direct depositI'd like to set up a payment planThanks for choosing to pay via PayPal, you will be redirected to the PayPal website after you click submit to complete your payment.You can make your payment into the following account: Account Name: Fusion Australia BSB: 112-879 Account Number: 054 789 932We will send a receipt when your payment has been receivedYou can make your payment into the following account: Account Name: Fusion Riverina BSB: 032-750 Account Number: 228211We will send a receipt when your payment has been receivedWe will be in touch shortly to discuss payment plan options.Total $ 0.00
