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Auslan Class
Enrolment Form
Deaf Services Queensland
PO Box 173 or 473 Annerley Road
Annerley QLD 4103
Fax: 07 3392 8511 Voice: 07 3892 8500
Title: Last Name: First Name :
(These names will be used on Certificate)
Address (1)
Address (2)
Suburb: Postcode: State:
Phone Number: Work Number: Mobile Number:
Email:
Amount: ID Number: (proof of concession or Full-time student only)
Course Code:
Choose one Payment Option :
 1. Credit Card 2. Direct Debit 3. Money Order 4. Cheque
1. Credit Card: Name on card:
Card Number: Expiry:
2. Direct Debit receipt Number Date: Descrption:
Direct Debit: Suncorp 484-799 Acc 006888131
Include your full name in details
 
 
3 & 4 Payable to Deaf Services Queensland
I have read and accept the conditions of enrolment. Signed:
(Please sign after you print. Fax and postal address details are on the top)
For office use only:    
Database
Date Paid:
Invoice:
Confirm Cancel
Receipt:
Initials: