Chemical Accreditation Registration Form

Chemical Accreditation Registration Form

Fill out your details below to express your interest for you or your business to participate in our courses. We'll get back to you with more information and schedules soon.
Business Information
Business Trading Name
Core Industry : Please choose most applicable.
If your industry is not listed, please note it in the box below.
If other, please note below :
What machinery or equipment do you use? Please choose most applicable.
If your industry is not listed, please note it in the box below.
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Postal Address (if different)

Street Address

Street Address Line 2

CityState / Province

Post Code
Contact Person*
Full Name
Contact for invoice if different (Optional)
Name and Email Address
Purchase Order Number (Optional)
Phone Number*

Area CodePhone Number
Email*
example@example.com

Course Location & Date*
See our training calendar to find the date you require. If you are enquiring about a location/date that is currently not on our calendar, please select 'other' then choose a location from the dropdown below.
Preferred Location / EOI For A Different Location
Promo Code
If you have received a promotion code, enter it here
I believe I may be eligible for the following funding:

SmartAg (Through Queensland Farmer's Federation)AgSkilled NSW (Conditional on Application)Other (Please contact me)Neither
SmartAg Reference:
Reference: Name of Growers Association & Name of Representative)
After you have completed this Registration form, you can apply for AgSkilled funding here: https://form.jotform.com/252251556106855

If you are unsure if you qualify for the funding, please speak to our office staff first.
Please provide details of possible funding you have heard about:
Attendee List*
How did you hear about our training?*
See our training calendar to find the date you require. If you are enquiring about a location/date that is currently not on our calendar, please select 'other' then choose a location from the dropdown below.
Preferred payment method to confirm your booking

Please email me an invoice for direct debitI will call with credit card details
Should be Empty: