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FREE BUSINESS LISTING FOR PRIVATE PRACTITIONERS
If you would like one free listing for the
Private Practitioner Directory Series in the Directory of your choice
for 2000 - 2001 then act now. Select the Directory in which you would
like to position your business and post your completed details to:
Karen Miles, Principal
Australian Rehabilitation Online
PO Box 3082, South Brisbane BC
Brisbane, Qld 4101
Phone/Fax: 07 - 3844 6388
Email: karen@ rehabilitationonline.com.au
Please Print, Complete and Post this page:
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Page
| 1.
SELECT DIRECTORIES |
| DIRECTORIES: |
YES/NO: |
| 1.
Sports |
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| 2.
Health |
|
| 3.
Education and Children |
|
| 4.
Separation and Counseling |
|
| 5.
Work |
|
| 6.
Personal Injury |
|
| 7.
Consulting to Business the Arts and Industry |
|
| 2.
APPLICANT DETAILS |
PRACTICE
BUSINESS NAME:
|
| PRACTITIONER
NAMES: |
PROFESSIONS: |
| 1. |
|
| 2. |
|
| 3. |
|
| PRACTICE
ADDRESS (include suburb, state and postcode) |
| 1. |
| 2. |
| 3. |
| ABN
(Australian Business Number) |
| 1. |
| 2. |
| 3. |
| 3.
QUALIFICATION REQUIREMENTS List the State or Territory Registration
Board/Full membership of Professional Association and and registration
numbers. |
| 1. |
| 2. |
| 3. |
| 4.
Describe your Free Business Entry for the database. |
PRACTICE
BUSINESS NAME:
|
PRACTITIONER
NAME:
|
PROFESSION:
|
ADDRESS:
|
| PHONE
1: |
PHONE
2: |
| FAX: |
EMAIL: |
| DIRECTORY
PREFERENCE: |
5.
Declaration and Terms.
The
practitioners listed herein are registered with an Australian State
or Territory Registration Board/Professional Association. Registration
numbers and ABN's have been included. I accept that Australian Rehabilitation
Online reserves the right to remove any name from the database for
the accuracy of the reader and for reasons beyond its control. I understand
the jurisdiction is Australia and that I will be contacted by Australian
Rehabilitation Online to confirm by application. |
| 1.Signature:
|
Date: |
| 2.Signature: |
Date: |
| 3.Signature: |
Date: |
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