Silver Medallion Patrol Captain Course Booking Form
Silver Medallion Patrol Captain Award
SLSQ Branch
*
Please Select
North Queensland Branch
North Barrier Branch
Wide Bay Capricorn Branch
Sunshine Coast Branch
South Coast Branch
Point Danger Branch
SLSQ Host Venue
*
Please Select
Agnes Water
Alexandra Headland
Arcadian
Ayr
Bilinga
Bribie Island
Brisbane Lifesaving Service
Broadbeach
Bundaberg
Burleigh Heads Mowbray Park
Cairns
Coochiemudlo Island
Coolangatta
Coolum Beach
Currumbin
Dicky Beach
Eimeo
Elliott Heads
Ellis Beach
Emu Park
Etty Bay
Forrest Beach
Hervey Bay
Kawana Waters
Kirra
Kurrawa
Lifeguards
Mackay
Marcoola
Maroochydore
Mermaid Beach
Met. Caloundra
Miami Beach
Mission Beach
Mooloolaba
Moore Park
Mudjimba
Nobbys Beach
Noosa Heads
North Barrier Branch
North Burleigh
North Kirra
North Queensland Branch
Northcliffe
Operations Support
OTHER
Pacific
Palm Beach
Peregian
Picnic Bay
Point Danger Branch
Point Lookout
Port Douglas
Rainbow Bay
Rainbow Beach
Redcliffe Peninsula
Sarina
South Coast Branch
Southport
Sunshine Beach
Sunshine Coast Branch
Surfers Paradise
Tallebudgera
Tannum Sands
Tugun
Tweed Heads & Coolangatta
Wide Bay Capricorn Branch
Yeppoon
Please select the Host Venue
Details of person submitting form
*
Full Name
Position
Email of person submitting form
*
example@example.com
Mobile Phone Number of person submitting form
*
Please enter a valid phone number.
Format: 0000 000 000.
Details of Branch Executive approving course
*
Have you organised a SMPC Facilitator for the course?
*
Yes - Please complete details in next field
No - Please assist with appointing a Facilitator
Details of Facilitator for Course
*
SMPC Course Start Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
SMPC Course Assessment Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Training Session Details
*
Alternative Training Locations - type any other locations you may utilise
List any Probationary TAF's
Do you require any equipment
*
Please Select
No
Yes
If yes, Please advise details of equipment required.
Additional Comments
If your course is submitted within 21 days of the start date please provide sufficient reasoning below
Submit
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