Location  
 
 

Advertisers Registration Form

We have very competitive package rates for listing clinics with multiple locations. Please contact us for further information.

Business Details

Please enter your business details. * Denotes a required field and must be entered.

Business / Company Name *  
ABN / ACN Number  
Qualifications  
Authorised Contact Name *  
Address 1 *  
 
Suburb *  
State *  
Postcode *  
Phone *  
Fax  
Email Address *  
Website  
     

Please select the Associations of which you are a member :

* Hold the CTRL key down for multiple selections

Other Association(s) :



Listing Details

Please select between Premium or Standard listing:-

Premium Listing (includes company logo).
Number of categories to be listed :

Please nominate which categories you would like your advert to be listed in :

* Hold the CTRL key down for multiple selections


Standard Listing ($150 for single category listing without logo).

Please nominate which category you would like your advert to be listed in :


Monthly Specials

I am interested in participating in the Cosmetic Choice 'Monthly Specials' service ($75 for 1 Month).

eVoucher

I am interested in adding an 'eVoucher' feature to my Service Listing ($250 per annum).
View sample eVoucher. Available with Premium Listing Only.

* All prices include GST.


Payment Details

Cheque

Please make cheques payable to "Cosmetic Choice Ltd" and mail to :

Princess Tower
Level 6 Suite 605
1 Princess St
Kew VIC 3101


Credit Card
Visa
MasterCard
Name on Card
Card Number (No spaces please)
Expiry /

Where did you hear about CosmeticChoice? *  

Cosmetic ChoiceTM, Copyright © - All rights reserved 2008       Cosmetic Choice Ltd.     ACN: 116411708      
 

Warning: Unknown(): Your script possibly relies on a session side-effect which existed until PHP 4.2.3. Please be advised that the session extension does not consider global variables as a source of data, unless register_globals is enabled. You can disable this functionality and this warning by setting session.bug_compat_42 or session.bug_compat_warn to off, respectively. in Unknown on line 0