Enrolment Form

PLEASE NOTE: If you already have an account with Cosmetic Institute of Australia, please login to your account first via http://www.cosmeticinstituteofaustralia.com.au/course-login/ before submitting a new enrolment to avoid the form being declined.

Enrol in a course*
First Name*
Middle Name
Last Name*
Name and title to be printed on certificate*
Date of Birth*
Date Format: DD slash MM slash YYYY
Gender*
Your Profession*
Where was your licence issued?*
Medical Licence/AHPRA Number
Mandatory for Nurses/Doctors/Dentists
Please upload a copy of your licence
What experience in cosmetics have you got so far?*
Professional Qualifications * Year Qualified * Place *
Current Workplace Address*
Current Workplace City/State*
Current Workplace Post/Zip Code*
Current Workplace Country*
Your Phone Number*
(including country and area code)
Your Email*

Yahoo email is not accepted.
- Check If Using Current Workplace Address as Mailing Address
Your Mailing Address
Your City/State
Your Post/Zip Code
Your Country
How did you hear about us?*
Any Comments ( including any dietary requirements )
Total Price
$ 0.00
Coupon Code
Please Choose the Course to Enrol in

Professional Qualifications *	Year Qualified *	Place *

Enrolment Form

Please Choose the Course to Enrol in