APPLICATION FORM
Australian College of Hygiene
Correspondence Course
click here for instructions

Full Name _______________________________________________
Street Address ___________________________________________
Suburb/City _____________________________________________
State and Postcode _______________________________________
Telephone  _____________________ ______________________

Sex ________________________
Age ________________________
Marital Status ________________________
Occupation ________________________


Education

Primary


Secondary


Tertiary



A Brief statement explaining why you want to do the course.








Please enroll me for the course. I enclose a cheque/money order/cash to the value of ............
being full/part payment and agree to abide by the conditions.


Signature ________________________________________________

Date ________________________

Instructions

Print out and mail this completed form to:

The ARCADIA HEALTH CENTRE
31, Cobah Road, ARCADIA, NSW 2159

The basic fee for the full course will be $1500. This amount may be paid in full, or alternatively you may pay $300 on commencement and $100 a month for the next 15 months making a total of $1800. If two or more members of the same family wish to undertake the course all, except the first, will be at half the usual fee. I regret that we are unable to accept credit card payments. There is an additional charge of $200 for overseas students as this will necessitate additional mailing costs and airmail is very expensive.

Cheques etc. should be made payable to 'ARCADIA HEALTH CENTRE'.