IRB Training Information Form

1
Course Selection* This field is required.
Silver Medallion IRB Drivers Course
IRB Crew Course
2
Branch* This field is required.
Sunshine Coast
North Queensland
North Barrier
Wide Bay Capricorn
Sunshine Coast
South Coast
Point Danger
3
Wide Bay Cap Club Name* This field is required.Select your club
Branch
Moore Park
Bundaberg
Elliott Heads
Hervey Bay
Yeppoon
Emu Park
Tannum
Agnes Water
4
Sunshine Coast Club Name* This field is required.Select your club
Branch
Brisbane Life Saving
Noosa Heads
Rainbow Beach
Sunshine Beach
Coolum Beach
Marcoola
Mudjimba
Maroochydore
Alexandra Headland
Mooloolaba
Kawana Waters
Dicky Beach
Metropolitan Caloundra
Bribie Island
Redcliffe Peninsula
Peregian
5
South Coast Club Name* This field is required.Select your club
Branch
Brisbane Life Saving
Northcliffe
Broadbeach
Kurrawa
Mermaid Beach A.E.M.E
Nobbys Beach
Miami Beach
North Burleigh
Burleigh Heads Mowbray Park
Point Lookout
Coochiemudlo Island
Southport
Surfers Paradise
6
Point Danger Club Name* This field is required.Please Select your Club
Branch
Brisbane Life Saving
Tugun
Bilinga
North Kirra
Kirra
Coolangatta
Tweed Heads and Coolangatta
Rainbow Bay
Tallebudgera
Pacific Surf
Palm Beach
Currumbin
7
North Queensland Club Name* This field is required.Please Select your Club
Branch
Mission Beach
Port Douglas
Ellis Beach
Cairns
Etty Bay
8
North Barrier Club Name* This field is required.Please Select your Club
Branch
Eimeo
Mackay
Sarina
Forrest Beach
Arcadian
Townsville Picnic Bay
Ayr
9
Course Start Date* This field is required.Minimum 14 Days from submission date If your course is not submitted within 14 days of the start date you will be required to provide sufficient reasoning
Date
Day
Month
Year
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05
06
07
08
09
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11
12
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14
15
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18
19
20
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22
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Hour
00
15
30
45
Minutes
10
Course End Date/Assessment Start Date* This field is required.The course end date should be the same as the assessment date.
Date
Year
Month
Day
00
01
02
03
04
05
06
07
08
09
10
11
12
13
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15
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20
21
22
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Hour
00
15
30
45
Minutes
11
Lead IRB Details* This field is required.
First , Last name
Phone number
Email
12
Direct Supervisor or IRB Trainer with TAE Cert IV* This field is required.At least one IRB Trainer needs to hold a Cert IV or a Direct Supervisor must be allocated and recorded on the Course Training report.
First/ Last name
Phone number
Email
13
IRB Trainers* This field is required.
14
IRB Assessors* This field is required.
15
List any Probationary Trainers/AssessorsPlease type the probationary name and indicate if they are a Trainer (T), or Assessor (A)
First , Last name (A) / (T)
First , Last name (A) / (T)
First , Last name (A) / (T)
First , Last name (A) / (T)
16
Qualified IRBDs assisting (not TAF)
17
Are you the CTO* This field is required.
YESNO
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CTO Details* This field is required.
First , Last name
Email
19
Personal Details* This field is required.
First Name
Last Name
20
Approximate Number of Participants* This field is required.Participant enrolments close 3 day prior to first session date
21
Training Details* This field is required.The first session will be the commencement date of the course. The last session date will be the assessment date for the course.
22
Alternative Training Venues
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Number of IRB's* This field is required.
24
Additional commentsIf your course is submitted within 14 days of the start date please provide sufficient reasoning below
Should be Empty: