Perth Training Institute

Group Enrolment Form

You are about to book participants in a Health and Safety Representative (HSR) course.

Course Start date: 31 Mar 2025

Please fill in the Registration form below. Fields with a red * are required.

Available seats: 10

Organisation Name *

First Name *

Last Name *

Email Address * Please CC me at the above email address in correspondence to the following participants I am booking.

Phone Number *

Preferred Payment Method

Purchase Order

Participants

Surname

Given Names

Date of Birth

Gender

Mobile

Total price for participants: $891.00

Enrolment Fee: $891.00

I allow Perth Training Institute to store AQF Certificate/Parchment data related to these Students on the PowerQR Document Validation system for document validation purposes.