Kimberley Training & Assessing

Group Enrolment Form

You are about to book participants in a Gas test atmospheres course.

Course Start date: 03 Dec 2025

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

Available seats: 12

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

Full Course Cost:	$400.00	^{($400.00 per student)}
Payable for enrolment:	$400.00	^{($400.00 per student)}

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

Available seats: 12

Participants

Full Course Cost:

$400.00

($400.00 per student)

Payable for enrolment:

$400.00

($400.00 per student)

^{($400.00 per student)}

^{($400.00 per student)}