MD-Safety Enrolment Form

Name	Position
Organization	Agreement	I acknowledge that the information I have provided is accurate and correct as well as agree to the terms outlined below.
Address
Phone	Mobile
E-Mail	Fax

Please enroll the following persons for the courses listed below:
Please ensure correct spelling of names for certificates

Payment
Direct Deposit MD-SAFETY Country First Credit Union BSB – 802-097 Acc- 883323	Cheque Sent Please pay to: MD-SAFETY	Purchase Order Emailed Or Sent (Account Customers)

Terms
Cancellations	All cancellations or disputes must be notified in writing to one of the points of contact herein.
Refunds	Fees are fully refundable provided a cancellation notice is received seven (7) days prior to the original scheduled
Course	Commencement date. Fees will not be fully refunded unless a cancellation notice is received in the specified time.
Transfers	Agreement to transfer to another course date must be reached in writing (48) hours prior to the original course date
	.

MD-SAFETY - 26 Wandoo St LEETON NSW 2705
Ph 0427477476 Fax 02 59082347
Email: info@mdsafety.com.au Web: mdsafety.com.au

ABN 16 550 696 578