| *Course name: |
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| *Course location: |
If other, please specify location
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| *Course start date: |
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| *Full Name: |
Surname
Given Names
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| *Address: |
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| *Suburb/Town: |
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| *Postcode: |
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| *Telephone (home): |
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Telephone (work):
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| Mobile: |
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| Fax: |
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| *Email: |
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| *Date of birth: |
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| Have you previously attended a course at AST?
Yes |
Who is to make payment?
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| How is payment to be made?
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Credit Card Details |
| Name on card: |
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| Type: |
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| Card No: |
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| Expiry Date: |
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| Amount: |
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The following information helps our trainer deliver
the best training for the individual student's needs |
Next of kin
(in case of emergency) |
Name
|
Phone
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| Are there any medical conditions we need to be aware
of?
Yes |
If yes, please comment:
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| Do you have any special needs (eg. ethnicity, culture,
gender, age, functional diversity, personality or learning styles)
that our trainer/assessor can be aware of to tailor the course delivery
to suit your needs?
Yes |
If yes, please comment:
|
| Do you have basic levels of Maths and English?
Yes |
If not, please comment (help can be given):
|
What experience have you had in the area of this
training?
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What do you hope to achieve by completing this
course?
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| Current employer: |
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Type of work:
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| Drivers licenses: |
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What type of WorkSafe Certificates of Competency do
you hold?
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If attending Welding training, what welding qualifications
do you hold?
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If attending Welding training, what experience
have you had?
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