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PO Box 244    THE JUNCTION

NSW 2291 AUSTRALIA
FertAid Pty Ltd            [ABN 62-093-199-529] Quality Matters  
   
TAX INVOICE - PLEASE PRINT AND POST or FAX 61-(0)2-49-63-1228 TO SUBSCRIBE WITH PAYMENT. www:fertaid.com - office@fertaid.com

Clinic (group) Subscription to QAPon-line at FertAid.com for 2001

Registration Process

 1. Read the page 'About QAP-online.com'  including the Declaration.

 2. Read 'About Subscribing to QAP-online.com

 2. Read 'Review QAP Scheme available Read Fees

 3. PRINT to PDF and email to office@Fertaid.com OR post to FertAid  with payment.
 
 
 
Scheme Number/Discpline
Please Note: The list displayed is only for scheme that require a paid subscription. Other schemes that are free are not displayed.
Type of Subscription
 

 

 
Individual One Staff/One scheme Discipline * All staff/One Discipline
Scheme* All staff/one scheme Global * Al Staff/All schemes
*,QAP-online will create a record of your subscription as the QAP supervisor and your Clinic as a QAP group. Your staff will be able to register online, link their registration to your QAP group and then enroll online without further payment.
 
Payment

Please complete payment details for all staff in the one clinic. Please write clearly

Fee*
$USD
$AUD
Euro
Discipline
1000
11
500
Student
1000
11
500
Single
1000
11
500
Scheme
1000
11
500
Global
1000
11
500

*inc GST

Individual One Staff- one scheme
Scheme All staff- one scheme
Discipline All staff - one discipline
Global All staff- all schemes

 
AMOUNT DUE: $USD $AUD Euro
Cheque Credit Card Bank Transfer Order Number
Credit Card. Details: Card Holders Name [Please Print Clearly]:
VISA  MasterCard Bankcard  CVV 3 Digit Authority Code
Name on Card:    Signature:      Expiry Date:
       
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Direct Bank Transfer Payable to Commonwealth Bank of Australia   Acc Name: FertAid - Bank Code: CTBAAU2S  Acc No: 062-821-1009-4608
Transferring Bank
      Date Transfer Requested:
 Order Number:   Name of Authorising Authority:   Signature:

Contact Details

Details of Clinic and Contact Details of Authorised Staff Member

[your logon code and  password will be sent to this e-mail if completed- please print clearly]

Office Use Only:Clinic:_________

Logon:_________Password:___________
Your Full Name:
  - Signature Date :
Institution/Clinic
 
Address:
 
:Telephone:
  Fax:
  e-mail address::