WHEN EVERY SECOND COUNTScourse booking form Fill out the form below to book your Time Critical first aid and pre-hospital emergency care training course. CLIENT INFORMATIONToday's Date Date Format: MM slash DD slash YYYY Company NameCompany Contact* First Last Contact Email* Contact Telephone Number*TRAINING REQUIREDCourse Required*Please select your preferred course form the listHLTAID009 Provide cardiopulmonary resuscitationHLTAID011 Provide First AidHLTPAT005 Collect specimens for drugs of abuse testingHLTAID006 Provide Advanced First AidHLTAID007 Provide Advanced ResuscitationHLTAID009 Provide cardiopulmonary resuscitation with AnaphylaxisDate Course Required*These are tentative dates until confirmed by Time Critical. Date Format: DD slash MM slash YYYY Alternative Date*Please provide an alternative date for your required course. Date Format: DD slash MM slash YYYY Number of Participants*Min 6 - Max 14 Participants67891011121314More than 14 participantsPlease let us know your requirements if the course exceeds 14 participants.Theory Completion Option*Please select if the participants are to complete the theory component online as pre-requisite or on-course on the day.Online Pre-requisiteOn-courseTRAINING VENUETraining Start Time* : HH MM AM PM Training Venue Address*Please provide details of the training venue. Venue Name / Street Address Street Address Line 2 Suburb Post Code Additional Training Venue InformationPlease provide any additional information about the venue, e.g. access requirementsTechnical Training Resources*Trainers require a TV display monitor to deliver the course. Please let us know what your facility currently have. We have a TV with a USB connection. We require a USB cable to connect to the TV. We require a projector and screen ACCOUNTS PAYABLEPlease provide the contact details of the person responsible for the accounts.Name* First Last Email* PhonePurchase Order Number(Optional) If your company operates on purchase ordersACCEPTANCE AND AUTHORISATIONBy providing this booking form, you as the client confirm that the venue is suitable for training and assessment. This includes a large enough space for the intended number of participants, suitable facilities such as breakrooms and toilets, including disabled toilets. It is safe and hygienic and ready for the use of training and assessment.Name of Authorised Person First Last Consent* I accept the terms and authorise the bookingCAPTCHAEmailThis field is for validation purposes and should be left unchanged.