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* Please fill in all required fields marked with asterisk(*).

Name*

First Last

Email*

Mobile Phone*

Phone

Company Name*

Position

Date of Birth

Department

Dietary Requirements*

Please list any dietary requirements or allergies (e.g. vegetarian, gluten-free, nut allergy). We will pass these on to the venue catering team; however, please note that while all reasonable efforts will be made, we cannot guarantee all dietary needs will be accommodated.

Dietary (please specify)*

Address Details

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address Check

Tick if your billing address is different from above

Billing Address

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Course Enrolment Information

Have you attended infrared training in the past through us?*

Yes

Current Certification Level – PLEASE NOTE LEVEL 1 IS A PRE-REQUISITE FOR LEVEL 2*

None

Level 1

Level 2

I primarily use infrared for…

Other Infrared Purposes*

I am interested in 3rd Party Certification...*

Yes, please send me further information and booking instructions.

No, I only want to do training for now.

Trainee Declaration*

● I have downloaded/received and agree to abide by the IPI Learning's Training Policies.
● I have read and understood the Terms and Conditions of Registration.

I have read and accept the above.

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Course Date

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