"*" indicates required fields Course Details Please confirm course details, date and pricesCourse Name*Location*Date*Price per personType ofBookingI'm booking this course as* As a Business (booking one or more staff members) As a Individual How many staff members are you booking?* One More than one Company DetailsYour Name* First Name Last Name Bookers Email* Company Name*Company Phone*Would you like to pay for this course now?* Yes with a purchase order Yes using a credit card Yes using CITB Funding No (Please note that if you choose no, this booking will be tentative only) Purchase OrderUpload Purchase Order*Max. file size: 50 MB.For multiple PO PDF Uploads, please email them to [email protected]Student DetailsStudent Name* First Name Last Name Student Email* Student Phone*Student USIStudent Date of Birth Day Month Year CITB Number*Address Street Address Suburb State Postal Code Staff Members Name Email Phone USI Number DOB Actions Edit Delete There are no Staff Members. Add Staff Member Maximum number of staff members reached. Staff Members Name Email Phone USI Number DOB CITB Number Actions Edit Delete There are no Staff Members. Add Staff Member Maximum number of staff members reached. PaymentWould you like to pay for this course now?* Yes Yes using CITB Funding No (Please note that if you choose no, this booking will be tentative only) CITB Number*PaymentCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name Total Booking Price* Price: $ 0.00 If you have chosen to pay with CITB funding, you will receive an invoice for the gap fee.
