Student Enrolment Form

 

Is this the first time you have enrolled with Australasian Fire & Safety?  YES  NO
If NO, when did you previously undertake this training? 
Course for which you wish to apply:
Date of Course:
Title: MR  MISS  MRS  MS  OTHER:
Gender: Male  Female
Surname:
Given Names:
Date of Birth
Address:
Suburb: State/Territory: Postcode:
Phone: (HM) (WK): (MOB):
Preferred Email:
CITB Number: (if applicable)

Workplace Contact/Invoicing Details
Company:
Name:
Position:
Postal Address:
Suburb: State/Territory: Postcode:
Phone:     Purchase Order No:

Emergency Contact
Name:
Relationship:
Phone:

Course Conduct

In submitting this electronic enrolment form you agree that your failure to advise Australasian Fire & Safety of your inability to attend with a minimum of 24 hours notice to the above mentioned course, will incur a fee of 20% of the course cost.  Please tick to confirm your agreement

A confirmation email will be sent to the senders email, it is the senders responsibility to circulate this to course attendants.
 
Please copy the security code below before sending:*