Application Application Form Application Form 2017 Please fill out all items. if you have any query you can email on [email protected] Name* First Email* Address* Street Address Gender*MaleFemaleWebsite* Date* Date Format: DD slash MM slash YYYY Do you have industry experience?*YesNoIf yes, how long?* Years: Month: Are you currently trading?*YesNoHave you undergone prior training?*YesNoIf yes, please list:*Are you self-employed?*YesNoTrading Name:* First Are you an employee?*YesNoEmployer details:Company: First Address: First Contact: First Email: First Phn: First Fax: First Do you have your own equipment?*YesNoPlease list:*Do you have any special needs? E.g. hearing, sight:*YesNoPlease list:*Are you an Australian citizen?*YesNoIs English your first language?*YesNoHow would you rate your reading/writing skills?*LimitedGoodVery GoodDo you qualify for any funding?*YesNoHighest schooling level?*YesNoPlease list any schooling levels or certifications you have achieved:Please tick the course you would like to complete. Please tick Your preferred optionsPriceThe carpet and upholstery cleaning course: Course manual Theory on fibres, construction theory (1 day) Methods and Chemistry theory (1 day) On-the-job training for one full day Main Course* Select Course Price Price: $1,599.00 If further full-day practical is requiredAdd full-day practical $799.00 Price Price: $799.00 Advanced Spot and Stain RemovalAdd Stain Removal Course $999.00 Price Price: $999.00 WHS module (full day)Compulsory for those wanting Association membershipAdd WHS Module $799.00 Price Price: $799.00 Odour ControlAdd Odour Control $799.00 Price Price: $799.00 Leather CleaningAdd Leather Cleaning $799.00 Price Price: $799.00 Soil and Stain Protection (1/2 day)Add Topical Applications $399.00 Price Price: $399.00 Customer ServiceAdd Customer Service $599.00 Price Price: $599.00 Total $0.00 A discount of 15% will apply if 3-4 modules are required, 5-6 modules will give you a 20% discount. If all options are taken, price will be $3800 instead of $5193 Probationary Members of the Carpet Cleaning Association of WA will also qualify for an extra 10% overall discount. Please indicate your date preferences Preferred training datesDate Date Format: DD slash MM slash YYYY Date Date Format: DD slash MM slash YYYY Date Date Format: DD slash MM slash YYYY All modules include all materials and literature as needed and Certificates of Completion will be given. Full Membership to CCAWA will be considered after written and oral assignments for the above have also been completed, along with an inspection of your vehicle and equipment set up. This iframe contains the logic required to handle Ajax powered Gravity Forms.