Priority Training Program Application Form

Head Office Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Postal Address (Optional)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Client Portal Contact is the same as Primary

Tick if the Primary Contact will also manage the portal.

Name (Optional)

First Name

Last Name

Phone (Optional)

Country

(###)

###

####

Accounts & Invoicing Contact is the same as Primary

Tick if the Primary Contact will also manage the accounts & invoicing.

Name (Optional)

First Name

Last Name

Phone (Optional)

Country

(###)

###

####

Purchase Order Required?

Yes

No

Types of training your business requires *

CPR

First Aid

Advanced Resuscitation

Fire Safety

Work Safely at Heights

Confined Spaces

Other

Preferred Training Delivery Mode *

Onsite

Public Courses

Hybrid Mix

Confirmation of ability to meet scheduling requirements *

I understand and agree to provide adequate notice when scheduling training

Confirmation of ability to pay invoices within agreed terms *

I agree to payment terms as set out in the delivery contract

Acknowledgement of Workplace Health & Safety responsibilities for hosting onsite training *

I confirm the business can provide a safe and compliant training environment

I confirm that the information provided is true and correct and understand that submission of this form does not guarantee acceptance into the Priority Training Program. *

I confirm

Date *

MM

DD

YYYY