Online Enrolment Accredited

COURSE REGISTRATION FORM (TA 3.20 v2.1)

* Indicates required field

Title *

Name *

First

Last

USI Number *

Residential Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Number *

DOB Day *

Month *

Year *

Gender *

Male Female

Email *

Concession Card *

Yes No

If Yes, Card Type *

Card Number *

Do you have any special dietary, physical, cultural or educational needs that must be accommodated in order to participate in this course? *

Yes No

If Yes, Details: *

Organisation *

Phone Number *

Organisation Address *

Line 1

Line 2

City

State

Zip Code

Country

Course/s you wish to enrol in: *

Preferred Date/s (Not guaranteed) *

By submitting this form I acknowledge I have viewed the Progressive Training (WA) Pty Ltd Participant Handbook – available here – or at the office, containing information related to: RPL, Code of Practice, National Recognition, Course Outline, Assessment requirements, and have viewed/received Progressive Training (WA) Pty Ltd.’s Introduction PowerPoint.
I acknowledge that samples of my assessments may be used for Validation purposes.
I understand that my identity will be removed from all samples.

Conflict of Interest *

Yes No

If Yes, Details *

Please note: For registration to be confirmed, this completed registration form along with a deposit or a purchase order number must be returned to Progressive Training (WA) Pty Ltd at least 5 working days before course commencement date. Courses run subject to minimum numbers. Progressive Training (WA) Pty Ltd reserves the right to cancel or postpone courses. Prospective participants will be duly notified and if possible a suitable alternative will be offered.

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