S hort course E nrolment Form

PLEASE PRINT CLEARLY

PHONE FACSIMILE MAIL IN PERSON
Enrolments by credit card. Enrolments by credit card or invoice Mail completed enrolment Bring enrolment application
Visa or Mastercard. to company (with authorisation letter application to: and payment to any NMIT campus.
(Diners and AMEX not accepted.) or Purchase Order). Short Courses, NMIT, Hours: Mon-Fri 8.45am-5.00pm
Phone 03 9269 1200 Visa or Mastercard. 77-91 St Georges Road,
Hours: Mon-Fri 8.45am-5.00pm (Diners and AMEX not accepted.) PRESTON VIC 3072
Fax No: 03 9269 1484 Cheque or money order (Payable
to NMIT) must accompany form.

STUDENT DETAILS
Is this your first NMIT course? Yes No Student Number (if known):

Family Name: ______________________________________________________________________________________________________________________ First Name: _______________________________________________________________________________________________________________________________

Address: _ _____________________________________________________________________________________________________________________________ Date of Birth: ___________________ / __________________ / _________________ Female Male

__________________________________________________________________________________________ ____________________________________________________
Suburb Pos t code
Phone: _____________________________________________________________ __________________________________________________________________ _______________________________________________________________________
HOME Work MOBILE
Email: _____________________________________________________________________________________________________________________________________ Fax: ____________________________________________________________

COURSE DETAILS Complete one enrolment form per person for each course.

Course Title: _ ___________________________________________________________________________________________________________________________________________________________ Course Code: _ _____________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________ Fee: $ _ _________________________________________________________________________________________________

Campus: _ ____________________________________________________________________ Start Date: ___________________ / __________________ / _________________ Day: _ ___________________________________________________ Time: ___________________________________

Payment DETAILS NMIT – ABN 502 301 652 43

Cash Money Order Cheque Visa Mastercard EFTPOS NO Diners/AMEX

Credit Card No: Expiry Date: ___________________ / __________________

Cardholder’s Name: __________________________________________________________________________________________________________ Cardholder’s Signature: _________________________________________________________________________________________________________

OR invoice company (Authorisation letter or Purchase Order required. Subject to approval.)

Company Name: _ _______________________________________________________________________________________________________________ Company Address: _ ________________________________________________________________________________________________________________

Phone: ___________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________

Fax: ________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________ _ ___________________________________________________

Suburb Pos t code

How Did You Hear about nmit short courses ?

1. Where did you see your course advertised?
Newspaper advertisement : Leader Newspaper The Herald Sun The Age Other ________________________________________________________________________________________

Outdoor Poster NMIT website Google Other website _______________________________________________________________________________________________________________________________________________

2. What influenced your decision to enrol in this course?
Location Course content Known teacher/staff member NMIT reputation Family or friend recommendation

Other ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

IMPORTANT
DOC ID: B/IS/F/7/405 • Edition 4: 10 February 2010

I accept NMIT's Terms and Conditions (See page 30). _ Student Signature: _________________________________________________________________________________________________________________

• All enrolments will receive a confirmation letter (including date, time, course, location, receipt and parking permit) by mail.
Please call Short Courses on 03 9269 1200 if you haven’t received this prior to course commencement.
• Enrolments can only be accepted if accompanied by payment.

Office Use only

Register Operator: ____________________________________________________________________________ Date: ___________________ / __________________ / _________________ Receipt No: ___________________________________________________________________________

Enrolled on Strata by: ____________________________________________________________________________________________________________ Date: ___________________ / __________________ / _________________

Check out the latest updates to NMIT Short Courses at www.nmit.vic.edu.au/shortcourses 35