Enrol • Country X-Ray Training

To enrol simply download and return the enrolment form via email to admin@cxrt.com.au OR enrol online using the form below.

One of the team will contact you soon!

Surname*
First Name*

First name (Preferred name that will appear on your course ID badge)
Street Address*
Suburb*
State
Postcode*
Postal Address*
- Same as above
- Other
Postal Address
Street Address Address Line 2 City State Postcode
Email*
Phone (Mobile)*

04xx xxx xxx
Phone (Work/Other)
Dietary Requirements
Please enter any special dietary requirements or requests here.
Are you a General Practitioner or a Registered Nurse?*
If other, please state what profession?
Please specify which course date you wish to enrol for?
Which state will you be applying for a radiation licence?
Are you AHPRA registered?*
Are you training with ACRRM or RACGP?*
Where will be your location of practice?

Please record the location/name of centre that you will be primarily performing xrays
Insurance*
- I accept
I understand that Country X-Ray Training cannot cover me for Professional/Personal Indemnity Insurance.
Cancellation Fee*
- I accept
I understand that an administration fee applies for cancellation.
Terms & Conditions*
- I agree
I understand and agree to the terms and conditions.
Future Enrolment?*
If your selected course is full. Do you wish to apply for a subsequent course?
Who would you like the tax invoice addressed to?