2021 Mitsubishi Mirage ES

Contact Details

Business Details

Are you GST Registered? ---YesNo Is an Accountant used? ---YesNo


Working arrangement I own the schoolI am a subcontractor / Employee

Tranmission Type: ---AutomaticManual Are disabled driver controls fitted? NoYes
Do you need to enter information for another vehicle? ---YesNo

Membership Details

Can we list you on our publicly accessed website? YesNo Receive our email updates & News? YesNo

Area(s) which you service: SydneyHunterNorthSouthSouth WestWest
Languages you speak and understand (other than English):
Do you have NRMA roadside assist or similar? ---YesNo
Are you a current Older Driver Assessor? ---YesNo
Are you an HVCBA Assessor? ---YesNo

Are you Keys2drive Accredited? ---YesNo

Are you Driver Rehabilitation qualified? ---YesNo
Do you have a Cert IV in Driving Instruction? ---YesNo

Do you have a Cert IV in Training and Assessing? ---YesNo

Do you teach the NSW ‘Safer Drivers Course’? ---YesNo

Were you referred to NSW DTA through an existing member?
I have read and agree to follow the NSW DTA Member Terms & Conditions.
Please make payment through direct deposit and enter your receipt number below. Bank details: St George 112 879 a/c NSW Driver Trainers Association 429 731 615.