Training Course Registration Form

advertisement
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
Download