AFM COURSE REGISTRATION
	Please print out this form and complete  using BLOCK LETTERS and return with payment to: Australian Food Microbiology, PO Box 246, Round Corner, NSW, 2158.

Personal Details

Surname:   ........................................................................................................................................   

First Name (Mr / Mrs / Miss / Ms / Dr ):   .............................................................................................  

Job Title:   ..........................................................................................................................................

Organisation:  ....................................................................................................................................

Address: ...........................................................................................................................................

...........................................................................................     Post Code:   .....................................

Phone Number: .................................................  Fax Number:   ......................................................

Email Address:  .............................................................................

Course (tick appropriate box)

Course start date:  ...........................

Payment Details

Course Cost:  $ ........................................

        I enclose a cheque made payable to: Australian Food Microbiology

Booking Conditions

Cancellations notified in writing not less than 7 days before commencement of training will receive a full refund.  Refunds will be made within 14 days.  Participants may be substituted with the permission and knowledge of Australian Food Microbiology.

Signature:                                                    Printed Name: