Enrol To enrol simply download and return the enrolment form via email to firstname.lastname@example.org OR enrol online using the form below. One of the team will contact you soon! Online Enrolment Form Surname*First Name*First name (or preferred name that will appear on your course ID badge)Street Address*Suburb*Postcode*Postal Address* Same as above Other Postal Address Street Address Address Line 2 City State Postcode Email*Phone (Mobile)*04xx xxx xxxPhone (Work/Other)Dietary RequirementsPlease enter any special dietary requirements or requests here.Are you a General Practitioner or a Registered Nurse?*General PractitionerRegistered NurseOtherIf other please state what profession?Have you held a previous radiation licence number?If yes, please specify your previous radiation licence numberWhich state will you be applying for a radiation licence?SAWAVICNTNSWQLDTASACTAre you AHPRA registered?*YesNoWhere 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.CAPTCHATerms & Conditions* I agree I understand and agree to the terms and conditions.Future Enrolment*YesNoIf your application arrives after the closing date or the course is full, do you wish to apply for a subsequent course?