Student Enrolment Form

TITLE: DR/MR/MRS/MS/MISS/OTHER *

PREFERRED NAME

FIRST NAME *

MIDDLE NAME

LAST NAME *

DATE OF BIRTH *

YOUR GENDER *

EMAIL ADDRESS *

MOBILE *

WORK

BUILDING/PROPERTY NAME

FLAT/UNIT DETAILS

STREET ADDRESS *

SUBURB *

STATE *

COUNTRY *

BUILDING/PROPERTY NAME

POSTAL STREET ADDRESS

PO BOX

SUBURB

STATE

POSTAL COUNTRY

I AM ELECTING TO ENROL IN THE: *

YOUR TRADING MENTOR COURSE

SHORT COURSE IN SHARE TRADING*

SHARE TRADING AND INVESTMENT COURSE*

FOREX AND CFD TRADING COURSE

SHORT COURSE TO SHARE TRADING AND INVESTMENT COURSE*

ADVANCED TRADING STRATEGIES COURSE*

SPECIFY THE MONTH YOU WILL BE THE COMMENCING YOUR STUDIES

BANK TRANSFER (DATE OF TRANSFER) *

PLEASE DEBIT MY

CARDHOLDER NAME

CARD NUMBER

CREDIT CARD EXPIRY DATE

CVV

AMOUNT A$

SIGNATURE *

DATE *

PARENT/GUARDIAN SIGNATURE

PARENT/GUARDIAN PRINTED NAME

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