Pyrotechnic Course Application Form

LIMITED SPACES AVAILABLE - (Immediate registration required for consideration of inclusion in the next course)

PYROTECHNICIAN FIREWORKS TRAINING COURSE

REGISTRATION FORM 2006

Pyrotechnician Firework Training Course Certificates are issued on completion of the course.

*is a required field

Name*: ...Address*:
Phone*: ...Mobile:
Email*: ...Age*:
Occupation*: ...D.O.B*:

Reason for wishing to participate in course *:

Payment $2,200 inc. G.S.T. (Must be paid in full before commencement by student).

A deposit of $750 must accompany this form or registration shall not be processed.

Enquiries regarding course may be directed to Keith Lewis (03) 9525 4316

Fax: (03) 9525 3044