Booking form Your Contact Information First name:*Last name:*Date of birth:Address:City/Suburb:State:WA Western AustraliaNSW New South WalesNT Northern TerritoryQld QueenslandSA South AustraliaTas TasmaniaVic VictoriaOtherPostcodeHome Phone:Mobile:*E-mail:*How did you hear about us?*WebPublicationReferralOtherCourse informationPreferred course date:*April 2019 - Mon 8th Tues 9th Wed 10thApril 2019 - Mon 22nd Tues 23rd Wed 24thMay 2019 - Mon 6th Tues 7th Wed 8thMay 2019 - Mon 20th Tues 21st Wed 22ndMay 2019 - Mon 27th Tues 28th Wed 29thJune 2019 - Mon 3rd Tues 4th Wed 5thJune 2019 - Mon 10th Tues 11th Wed 12thJune 2019 - Mon 24th Tues 25th Wed 26thAug 2019 - Mon 5th Tues 6th Wed 7thAug 2019 - Mon 19th Tues 20th Wed 21stFinding your way around the bush / Friday 26th – April 2019Finding your way around the bush / Friday 14th – June 2019Finding your way around the bush / Friday 9th – Aug 2019 Advanced research methods / Friday 24th – May 2019Advanced research methods / Friday 23rd – Aug 2019Pegging a lease / Friday 28th – June 2019WA Miner's Right number:APLA Membership number:Type of Vehicle:Vehicle Registration:Do you own a metal detector? If so, what type?How experienced are you in using a metal detector?Preferred method of payment:* Cheque Direct Transfer Would you like to prospect on one of our tenements after the course?*YesNoSafety informationNext of kin contact name:*Home Phone:Mobile:*Relationship:*Do you have any medical conditions of which we should be aware of?*NoYesDo you take any medication of which we should be aware?*NoYes This iframe contains the logic required to handle Ajax powered Gravity Forms.