Enrolment Form: Day Walk Leader Training Course & Day Walk Leadership Certificate Level

Section 1: Enrolment
Name*
Prefix First Last
Date of Birth*
MM slash DD slash YYYY
Phone 1 (suggest mobile)*
Phone 2 (suggest home)
Address*
Post Code*
Email Address*
Section 2: Payment
Year*
Course Dates*
Please select fee options*
- Enrolment Fee (Including Assessment) - $590
- Enrolment Fee (Including Assessment) - $530 - Concession
Please select your payment method*
EFT Bank Transfer:
Account Branch: ANZ (Marion Branch)
Account name: Bushwalking Leadership SA
BSB: 015220
Account Number: 476944904

Please put your name in reference to payment. When payment is made please email through the a receipt to blsa@bushwalkingleadership.org.au.

Over-the-counter bank transfer:
Bank: ANZ (any branch)
Account name: Bushwalking Leadership SA
BSB: 015220
Account Number: 476944904

Please put your name or phone number as the reference to payment. When payment is made please email through advise to blsa@bushwalkingleadership.org.au.
- EFT Bank Transfer
- Over-the-counter bank transfer
- Cheque / Money Order
Section 3: Your Background
Present Occupation/Course of Studies
Work/Study Address
Where did you hear about the Day Walk Leadership Certificate course?
Email
This field is for validation purposes and should be left unchanged.

Section 1: Enrolment