Preliminary Apply Form

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General Details

Title is a required field

Given name is a required field

Surname is a required field

Date of Birth is a required field

Residency Information is a required field

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Contact and Residential Address Details

Email is a required field

Please check your email address

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Please check your phone number

An Address is required

Line 1 is a required field

e.g. BROADMEADOWS

Suburb is a required field

Please enter a valid suburb

e.g. VIC

Please enter a valid Australian State

Please enter a valid state

e.g. 3047

Post code is a required field

Country is a required field

Can not enter P.O. Box as residential address

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By submitting this form I agree that Bendigo Kangan Institute may use my personal information to contact me about products and services provided by Bendigo Kangan Institute and it’s partners. I understand that Bendigo Kangan Institute may profile and share my personal data with its agents for the purposes of marketing fulfilment. From time to time, Bendigo Kangan Institute may contact me by mail, telephone, email, other electronic messaging services (such as text, voice, sound or image messages including using automated calling systems) or fax with information about Bendigo Kangan Institute’s products and services. I understand that I can opt out of receiving this information at any time by writing to Bendigo Kangan Institute, Pearcedale Parade, Broadmeadows or by calling 138 233.

Course Application

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