AUSTSWIM Certificate and Licence Reprint Request

Personal Information

AUSTSWIM Licence Number*

First name*

Last name*

Postal Address*

City/Suburb*

State*

Postcode*

Mobile phone number*

Email*

All fees incl. GST

Certificate Pack - $25.00 per pack (incl. Statement of Attainment & Certificate of Accreditation)

Please tick which certificates you currently hold and would like re-issued.

Teacher of Swimming and Water Safety

Teacher of Infant and Preschool Aquatics

Teacher of Aquatics - Access and Inclusion

WETS Aqua

Certificate of Accreditation - $10.00 each

Teacher of Swimming and Water Safety

Teacher of Infant and Preschool Aquatics

Teacher of Aquatics - Access and Inclusion

Teacher of Adults

Teacher of Towards Competitive Strokes

WETS Aqua

Statement of Attainment - $20.00 each

Teacher of Swimming and Water Safety

Teacher of Infant and Preschool Aquatics

Teacher of Aquatics - Access and Inclusion

WETS Aqua

Please tick this box if you would like to receive a digital copy of your certificate.

In order to process your reprint request please complete the payment details section of the form

Payment Details

Cardholder's Name

Card Number

Card Expiry Date

CVV Number

Please Invoice Organisation (purchase order must be attached)

Attach Purchase Order Here

Organisation Contact Name

Company Address

Phone number