1 Day HSR Refresher Registration Form

Comcare Approval - HSR010
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)

Accounts payable email :

Purchase Order Number : (Enter purchase order number if applicable)

Select Course Date/s :

Participant/s details:

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

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 7 days of the invoice date or before the course start date, if less than 7 days of the invoice date; and
ii) any cancellations will be made 21 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 21 days before the course start date; 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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