Initial 5 Day HSR Registration Form

Comcare Approval - HSR 010
Please scroll down and complete all required information.
A tax invoice will be emailed to the accounts payable email address entered below and can be paid by eft or credit card.

Contact Name :

Contact e-mail :

Contact No : (If entering landline number, include area code)

PCBU : (Name of Company or Organisation)

Location : State : Post Code :

Accounts payable email : (Invoices will be sent to this address)

Purchase Order: (Enter purchase order number if applicable)

Select Course Date/s :

Participant/s details: (maximum 20)

Please enter a valide email address and phone number for each participant listed.
If entering landline number include area code.

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I am authorised by each of the persons and/or PCBUs listed in this form (including all partners/principals/directors) to:
a) complete this form; and
b) make these declarations
i) payment for all participants listed will be made by the PCBU within 14 days of the invoice date or before the course start date, if less than 14 days of the invoice date; and
ii) any cancellations will be made 15 business days before the course start date;and
iii)all fees paid will be retained by Job Safety Assistance Pty Ltd for cancellations made less then 15 business days before the course start date;and
iv) all outstanding invoices issued for the participant/s cancelling less then 15 business days before the course start date remain due and payable in full;and
e) acknowledge and accept the full "Registration Terms" on their behalf.
Enter the number as shown : - verification image, type it in the box

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