Members Booking Form

Company Name *

Please enter the name of your Company or Organisation

Booking Contact's Name *

First

Last

Please provide the name of the contact for this booking

Booking Contact's Email

Please confirm the main contact person's email address

Booking Contact's Phone *

Please confirm the main contact person's phone number

Membership Type

Please confirm the type of membership you have

Requirement

Please tell us your requirements

Details of Requirements

What are the nature of your requirement

Other

You selected 'Other' please tell us a little more

General

Which of the following General requirements do you need

More Details

You selected 'Other' please tell us a little more

Venue Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please confirm the address of the venue where the course is to be delivered

Venue Contact Number

Comments or Message

Signature (Touch Screen or Mouse)

Clear Signature

Using either a touch screen or your computer's mouse - please sign here to agree to the terms and conditions outlined below

Signatory's Name *

First

Last

Please confirm the name of the signatory and in doing so that they are authorised by the company or organisation to submit this booking