Technical Course Request

Course Application Form
Affiliate
Course Requested By

First NameLast Name
E-mail
Mobile Number
Which Region Are you from?
What is your role within the Affiliate?
Proposed Course Details
Proposed Course to be Delivered?
Proposed Course Date(s)? (DD/MM/YYYY)
If your proposed course is required to run over two nights please add in both dates.
Courses will proceed on proposed date based on faciliator/facility availability and minimum number of participants.
Proposed Course Start Time?

:HourMinutesAM/PM Option
Proposed Course Finish Time?

:HourMinutesAM/PM Option
Proposed Course Location Address?

Name of Venue

Street Address

CityState

Postcode
Does the Course Location have the following?
Estimated Number of Course Participants?
What local Affiliates are within a 2hr driving distance for this course to be promoted to?
Have you informed your Region about this Course?
Will your affiliate, school, or provider be covering the cost for participants to complete this course? (If applicable)
How would you like this course to be accessed?
Facilitator Details

NOTE: Facilitators must create a Learn.MySideline account to deliver Touch Football courses in Australia
Are you the Course Facilitator?
Do you have a Course Facilitator?
Does the Course Facilitator have a Learn profile?
Facilitator Name

First NameLast Name
Facilitator Email
example@example.com
Facilitator Mobile Number
Address (For delivery of course materials - if applicable)

Street Address

Street Address Line 2

CityState

Postcode
Course Confirmation
Additional Comments for Course
Should be Empty:

Course Application Form

Proposed Course Details

Facilitator Details

Course Confirmation