Solutions Semester Two - Training and Seminar Dates P: (02) 6282 6122 F: (02) 6282 6133 E: training@srcsolutions.com.au To register for one or more of our courses, please tick the appropriate box on the course calendar below, complete the attached registration form and fax both documents to (02) 6282 6133 or scan them and send via email to training@srcsolutions.com.au. Training Course Course Code Cost (GST inclusive) Tick choice (per participant) Case Manager Forum 9.00am – 5.00pm 9 August 2012 120809CMF TBA Health and Safety Representative (HSR) Course (Comcare accredited) 5 days: 9.00am – 5.00pm each day 24, 25, 31 July and 1, 2 August 120724HSR $990.00 (GST incl) 7, 8, 13, 14, 15 August 120807HSR $990.00 (GST incl) 18, 19, 25, 26, 27 September 120918HSR $990.00 (GST incl) 13, 14, 20, 21, 22 November 121113HSR $990.00 (GST incl) Mental Health First Aid 12 hours: 9.30am – 4.30pm 22, 23 May 2012 120522MHF $440.00 (GST incl) 3, 4 July 2012 120703MHF $440.00 (GST incl) 11, 12 September 2012 120911MHF $440.00 (GST incl) 7, 8 November 2012 121107MHF $440.00 (GST incl) ACT Health and Safety Representative (HSR) Course 5 days: 9.00am – 5.00pm each day 21, 22, 28, 29 and 30 August 120821ACT $990.00 (GST incl) 16, 17, 23, 24, and 25 October 121016ACT $990.00 (GST incl) Completing a Basic Workstation Assessment 3 hours: 9.30am – 12.30pm 23 August 2012 120823WSA $345.00 (GST incl) 6 November 2012 121106WSA $345.00 (GST incl) Note: SRC Solutions reserves the right to cancel, postpone or reschedule a course due to insufficient numbers or other unforeseen circumstances. If SRC Solutions is required to cancel a course, participants will be offered a rescheduled course or a full refund. Please note that SRC Solutions is not responsible for hotel, airline or any other expenses incurred. All course prices are GST inclusive. The prices include relevant course materials and morning/afternoon tea. Unless otherwise indicated, all training is delivered on our premises at Level 1, 74 Dundas Court Phillip. Additional courses may be scheduled if required, subject to demand. Our training courses can also be delivered in-house. Please call us on (02) 6282 6122 or send an email to training@srcsolutions.com.au for more information. Our other courses, which are available for in-house delivery or as public courses (subject to sufficient demand) include: Safety Inspections Managing the Invalidity Process Safe and Practical Manual Handling Managing the Fitness for Duty Process Health and Safety Committees Managing Complex Cases OHS and Injury Management for Managers Completing a Basic Workstation Assessment Working Safely in the Office Please call on (02) 6282 6122 for further information or to register your interest. Semester Two 2012 - Training and Seminar Dates Page 1 of 2 Training Course Registration Form Section 1: Course details Course Name: Location: Course Date(s): Course cost: Section 2: Participant details Note: Gender information is collected for statistical purposes only. Title (Mr/Mrs/Ms/Miss/Dr/Other – please specify) Gender: Name: Work Phone: Email: @ Male Female Mobile: Employer: Street or PO Box Address: City: State: Postcode: Do you have any special dietary requirements or food allergies? If yes, please provide details. Do you have any other needs in relation to attending this training course eg access, language assistance etc? If yes, please provide details. I understand and accept SRC Solutions’ Cancellation/Information Collection policies (see below) and I certify that the information supplied is accurate. Participant’s signature Date: / / Cancellation Policy: Cancellations must be submitted in writing. For cancellations received 10 working days or more before the course commencement date, the course fee will be refunded less a 20% administrative fee. Within 10 working days of the course, no refunds will be made although we would welcome a substitute participant (to be advised in writing). SRC Solutions reserves the right to cancel, postpone or reschedule a course due to insufficient numbers or other unforeseen circumstances. If SRC Solutions is required to cancel a course, participants will be offered a rescheduled course or a full refund. Please note that SRC Solutions is not responsible for hotel, airline or any other expenses incurred. Information Collection Policy: Your personal information is collected for the purposes of course administration, statistical analysis and program evaluation. Your information will not be used for any other purpose except as required or authorised by or under law. Section 3: Employer/Supervisor Contact details Name: Email: Phone: @ Fax: Section 4: Invoicing or Payment Details – PLEASE COMPLETE RELEVANT SECTION Invoice Authorisation Details (please note that you will be invoiced on receipt of this Registration Form.) Department/Organisation Name Business Group/Division/Branch Cost Code/Cost Centre Number For the Attention of (if applicable) Phone: Email: @ Payment Details (please note that the payment will be deducted from your credit card on receipt of this Registration Form.) Payment Method: Visa Mastercard Credit Card Number Bankcard Expiry date: Card Holder’s Name: Card Holder’s signature: Phone: Email: Semester Two 2012 - Training and Seminar Dates / @ Page 2 of 2