Nicotine Addiction, Smoking & Vaping Cessation
 Registration Form

Complete the details below to register and pay now for the online Nicotine Addition, Smoking & Vaping course.
If you have any questions please contact lifestylemedicine@avondale.edu.au.  

Click 'save' at the bottom of the form to return to your registration form at a later time.

If you already have an account, Sign In here

Personal Details

Please complete all fields below

Title*
Entity Data - Profile - Title
First Name*
Entity Data - Profile - First Name
Surname*
Entity Data - Profile - Surname
Date of Birth*
Entity Data - Profile - Birth Date
Mobile Number*
Entity Data - Contact - Home - Mobile Number
Email Address*
Entity Data - Contact - Home - E-mail Address
Current Position / Job Title*
Basic - Text
Business / Organization Name*
Basic - Text
Department Name (if applicable)
Basic - Text
Address (If your company is paying you can add their address here)


Unit/Flat Number (If applicable)
Entity Data - Address - Home - Unit/Flat Number
Street/Lot Number
Entity Data - Address - Home - Street/Lot Number
Street Name
Entity Data - Address - Home - Street Name
State (If living within Australia)
Entity Data - Address - Home - State
Post Code
Entity Data - Address - Home - Post Code
Country
Entity Data - Address - Home - Country
Digital Signature*
Basic - Digital Signature
Date*
Basic - Date

Payment

To finalise your registration for this short course please complete your payment via credit card.  A tax receipt will be available for you to access in your portal.  


Note: Earlybird discount is only available when paying via credit card, if an invoice is required for payment the full fee of $1999 is applicable. 

If you require an invoice please click "Save" and email lifestylemedicine@avondale.edu.au.  We will email an invoice to you, payment must be received prior to the the start date of the course.  The full fee will be applied.

 
Please note - this is a non-refundable course.  If you are not able to attend on any of the days the course is being delivered, you will have access to the recordings of the course via your learning portal for a limited time. 

Payment Options
Nicotine Addiction, Smoking & Vaping Registration (Early bird rate of $1750 is available until 4 February 2027) 		$1,590.91
$1,590.91
$159.09
$1,750.00

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