course application form · qualification or statement of attainment. if you don't have a usi...
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Course Application Form Please be advised this is not a guarantee for placement into any course, an email will be sent to confirm your booking.
Please note: All participants are required to perform CPR assessment on the floor.
Please return completed application form to: Email [email protected]
Course Preference:
Course Name:
Course Date: Course Price: $
Personal Details:
Title: First Name: Surname:
Email: Gender:
Date of Birth: USI*:
Home Phone: Mobile:
Address:
Do you have any particular requirements around language, learning or physical activities?
Details:
Do you work in the construction industry?
(Please choose one)Payment Details: Credit Card:
Name on Card: Signature
Exp /
Invoice to company†:
Company Name: Authorising Person:
Authorising Signature: Company Address:
Company Phone: Company Email:
Direct Deposit: Bank details for direct deposit are available upon request.
* If you are a new or continuing student undertaking nationallyrecognised training, you need a USI in order to receive your qualification or statement of attainment. If you don't have a USI you will not receive your qualification or statement of attainment. Visit www.usi.gov.au for more information and to register new users.† Only available to companies with a current St John ACT account.
Contact us
ST JOHN AMBULANCE AUSTRALIA (ACT) INC ABN 12 003 741 878
14 Thesiger Court (PO Box72) Deakin West, ACT, 2600
T 02 6282 2399 www.stjohnact.org.au
St John Ambulance Australia (ACT) delivers nationally recognised training in partnership with St John Ambulance Australia Inc (RTO 88041).