Application for Enrolment

Name

First NameLast Name

E-mail

example@example.com

Phone Number:

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

State

Where did you hear about our post graduate courses? (you can select more than one)

What kind of groups/classes are you running at the moment and how often?

What made you decide to enrol in this course?

Which course are you enroling in?

Do you want to include the Community Work Placement Program in your Study Plan?

Please note that supervision calls are held on Monday Evenings.

When would you like to begin this course?

If you are planning to begin the course in the future please specify when

This date helps us to reserve your spot with a coach for when you are ready to commence your studies

Have you had a Discovery Call?

Are you a ACMM Business Lounge Member? (Business Lounge members are entitled to a discount on all post graduate training courses, if you are not a member you may like to consider joining in order to receive this discount.)

Have you completed all your core Sessions, Assessment and Case Studies (Certificate level qualification)

Have you attended a ACMM Multi Day IN PERSON Retreat before?

How many ACMM Multi Day IN PERSON Retreats have you attended?

Have you attended an ACMM Multi Day ONLINE Retreat before?

How many ACMM Multi Day ONLINE Retreats have you attended?

Have you completed or enrolled (paid for) any electives?

How many electives have you completed or paid for?

Have you completed the Diploma supervision calls?

Please select your preferred payment option, after we have received your form we will be in touch with an invoice (for upfront payment) or personalised payment plan based on the components you still need to complete to obtain your new qualification.

Please note full payment or payment plan approval must be completed within 7 days.

Join the Business Lounge here straight after completing this form to receive the maximum discount.

Do you have a PROMO CODE, please enter here. Please note - only one discount/offer applies (either promotion or Business Lounge Discount).

Choose a payment method.

UPFRONT PAYMENT - BANK TRANSFER

Please transfer funds into the below account with your full name as the reference. We will send you a tax receipt and enrolment confirmation via email.

Name: ACMM Pty Ltd
BSB: 063 151
ACC: 1065 9320

PAYMENT PLAN

All of our payment plans are set up through our payment provider that we have been utilizing since 2002 - EZIDEBIT.

We will use the details provided on this form to set up a personalised payment plan and an Ezidebit account for you. Following that, you will receive an email from EZIDEBIT providing you with a secure link to register your credit card or bank account information. Please check your SPAM/PROMOTIONS folder for this email if you don't see it.

EziDebit Fees: Administration Fee (only on set up) up to $5.50 - Bank account transaction fee $1.19 - Visa/Mastercard service fee 2.07% (min $1.19) - AMEX service fee 4.40% (min $1.19) - Failed Payment fee $21.90. These fees are subject to change by EziDebit at any time.

Note: Certificates will not be issued until courses are paid in full. Community Work Placement payment plans can be up to 6 monthly only.

Payment Frequency

Payment Term

Date payments are to begin

Please note that your course can only begin after/on the first payment date

A minimum non refundable deposit of $250 is required to secure your place in your new course/s and will be deducted from your payment plan.

UPFRONT PAYMENT - CARD

Please use the below payment facility to process your payment, we will send you an email confirming your enrolment and setting you up with the course in the next 2 working days.

AUD$250 Deposit or total amount due

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

We are looking forward to getting you started on this exciting next phase of your learning journey!

Elevate Your Offerings

Personal Details

Course Details

Study plan

How would you like to pay for your course?