TO:       Developing Skills

           151b Wilding St. Doubleview, Western Australia 6018

            (phone (618) 94466330   mobile 0419 102746)

FROM:

(NAME)        __________________________________

(STREET)    __________________________________________________________________________

(TOWN)       ____________________________________   (STATE + PCODE)      __________________

(PHONE)      ________________  (MOBILE)   _______________  (EMAIL)  ________________________

Please tick as appropriate below:

                                                                                                       Course Date                Cost

(     )  I want to enroll in a Swim-Ability Course  . . . . . . . . . . . . . ..      _____________      $ ________

(     )  I want to enroll in a Manutention Course  . . . . . . . . . . . . . ..      _____________      $ ________

(     )  I want to enroll in a ______________________ Course  . . . . .     _____________     $ ________

(     )  I want to purchase ____ copies of the ‘Developing Skills in Water’ DVD  @ $30.00    $ ________

          *  Add $5.00 Postage for videos purchased – (no additional charge for extra DVD’s) $ ________

                                                                                                           TOTAL COST     $ ________

(     )  I am paying by enclosed cheque or money order.

(     )  I am paying by internet banking transfer from account name _____________________________

         please transfer payment to account ‘Developing Skills’ - -  BSB  736027 - -   ACCOUNT#  658955

(     )  I will make contact with you to make other arrangements for payment.

Payment for  courses includes all costs of manuals, site fees and registration fees with Austswim or AAMP as applicable.  Receipts will be sent to the address listed above.  Purchase of more than one video incurs no additional postage costs.  Please send cheque or money order for the total cost to the address listed above, or send payment by internet bank transfer.  Unfortunately credit card facilities are not available at this time. If using bank transfer, please record your name as the sender on the transfer details.