New Customer Registration Form

Registration Form For Workshop on 2nd August 2025 (1:30pm - 4:30pm)

1411 Fullarton Road, Fullarton
Customer Details:
Full Name Guest 1*

First NameLast Name
Full Name Guest 2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONI SIGNATURE THAT WILL HAVE THE SAME EFFECT AN AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL E EAUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. WITH THIS, I AGREE TO PARTICIPATE IN THIS WORKSHOP.
Signature

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My Products
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1 Pax Only
$57.00AUD Quantity

For 2 PaxFor 2 Pax
$97.00AUD Quantity

Total

$0.00AUD
Payment Details:

Bank : Commonwealth Bank of Australia

Account Name: Nicomax (Aust) Global Pty Ltd

BSB : 065141

Account: 10251749
*Please kindly upload your Payment Slip here:

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Registration Form For Workshop on 2nd August 2025 (1:30pm - 4:30pm)