First Aid Enrolment form

What course do you wish to attend?

______________________________________________________

Venue:
244 Grey Street Palmerston North
OR
4 Kent Street Levin
Please check you have the correct venue for the date

Full First Aid -2 days:

DATE:_____________________

Revalidation of current certificate:

DATE:_____________________

8 hour First Aid:

DATE:_____________________

Electrical registration First Aid:

DATE:_____________________

Electrical registration Safe Work Practice:

DATE:_____________________


Name:__________________________________________


Postal address:__________________________________________

______________________________________________________


Phone:__________________________________________


Fax:__________________________________________


Email:_________________________________________________


Work phone:__________________________________________

Payment details: (indicate 'yes')

_____ Please find enclosed course fee $160.00 incl GST

_____ I will make a Direct Credit payment into your Bank Account
             Bank details for Direct credit: BNZ Levin, 02 0668 004081 00
             (Please use your name as reference)

Invoice details:

Name :_______________________________________________


Address:______________________________________________

_____________________________________________________

Attention :_____________________________________________

Authorization No. :_______________________________________


Telephone number: _____________________________________

GST registered receipts will be issued with confirmation of your place on the course.

We do accept cash at our office at 244 Grey Street Palmerston North.

Links undertakes to protect the confidentiality of personal information in accordance with the provisions of the Privacy Act 1993