New Student Registration

Student Details:

Name: *

First

Last

Mobile Number: *

Email: *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Date of Birth: *

Is the Student over 18 years of age at time of first lesson? *

Yes
No

Emergency Contact Details:

In the event of an emergency (medical or otherwise) the following person should be notified:

Emergency Contact Name: *

First

Last

Relationship to Student: *

Is Emergency Contact's Address same as Students? *

Yes
No

Emergency Contact Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Mobile Number:

Enrollment Information:

Which location will you be learning from?

Barwon Heads
Bendigo

Which Course are You Enrolling In today: *

Do you authorise Great Southern Flying School to use photographs & video obtained during your lessons in our marketing & promotional material (including digital & print). *

Yes
No