ISI Booking 2022.03.09 - Site WorkReady

Do you work for a Safer Together member Company? *

Company Name *

Company HR/contact and telephone for verification

Attendee details

Name *

First

Last

Phone *

Email *

Date of Birth *//

Unique Student Identifier (USI) Number

Find your USI number .... Click here

Postal address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is your home address the same as your postal address *

Home address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Course registration fee

Non Safer Together member fee (GST Inclusive) *

Price: $ 715.00

Safer Together member fee (GST inclusive) *

Price: $ 495.00

Credit Card *

Card

Name on Card

Email address for tax invoice

Declarations

Do you have any language or digital literacy issues that may impact your training? *

If yes, please indicate which area? *

Concerns with spoken english
Concerns with reading and writing
Concerns using computers and online tools

Do you consider yourself to have a disability or impairment that may impact your training? *

If yes, please indicate the area of disability or impairment? *

Please indicate other

Agree

I agree to allow the result of this Program (i.e., pass or fail) to be conveyed to your employer and to a database managed on behalf of the Industry by Safer Together or its agent. This nomination process is designed to comply with relevant Privacy legislation.

Agree

I understand that information collected about me on this form can be provided, in certain circumstances, to the Australian Government and designated authorities. In other circumstances, it can be disclosed without your consent where authorised or required by law, in accordance with the Privacy Act 1988.

Signature