Interest Registration - SM Safety Training

IOSH Managing Safely

REGISTRATION OF INTEREST - Please complete this form fully. This information will be retained for certificate verification, re-issue – as well as for compliance reasons.
Course Details:

Course Title: IOSH Managing Safely

Location: Online via Teams
Please select the course date you wish to register for:*

August 11th-13th 2025
Student Details:
Title*
First Name*
Surname*
Address*

House number and Street name

Street Address Line 2

CityCounty

Post CodeCountry
Nationality*
Date of birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Main email*
example@example.com
Medical Declaration:

Your safety as a student is paramount; please complete the following and provide details of any medical conditions, disabilities or impairments you think we may need to be aware of.
Please select all that apply*

Hearing DifficultiesAllergiesBack/Joint PainRespiratory ConditionEpilepsyVision ImpairmentHeart DiseaseDyslexiaN/AOther
Consent and Registration
By signing this form, you are confirming that you have entered the information required and that you accept our terms and conditions.
Signature

Clear
Date

DayMonthYear
Date
www.smsafetytraining.com Email: info@smsafetytraining.com

Phone number: 07540057755 or 01980 731706
Should be Empty:

IOSH Managing Safely