Training Course Registration Form

Registration Form

FOR COURSES LISTED IN THE 2010 TRAINING COURSE DIRECTORY

COURSE DETAILS

Course Name:

Course Code:

Assessment Option:

Take assessment option

Do not take assessment option

Note:Assessment Options are only available on selected courses.

Membership:

Member

Non-member

Location:

Start Date:

Course Fee:

DELEGATE DETAILS

* First Name:

* Family Name:

Designation

* Telephone:

Fax:

* Email Address:

* Company Name:

* Company Address:

Postal/Zip Code:

Dietary Requirement:

Medical Condiition to Declare:

PAYMENT OPTION 1 CREDIT CARD

Credit card payment is not available online for security reasons. Please contact Oil Spill Response for details.

PAYMENT OPTION 2 CHEQUE

Cheque can be made in UK£ Sterling, Euros, US Dollars or Singapore Dollars and mail together with this form to the respective address above. Please make payable to: OIL SPILL RESPONSE LIMITED

For course codes beginning with ‘U', please mail to:

Oil Spill Response
Lower William Street, Southampton SO14 5QE
United Kingdom

For course codes beginning with ‘S', please mail to:

Oil Spill Response
2 Jalan Samulun, Singapore 629120

PAYMENT OPTION 3 BANK TRANSFER

Bank transfer for courses can be made in UK£ Sterling, US$ or S$. Please refer to Payment Terms & Conditions under point 22 for more details.

PAYMENT DETAILS

* Attention to:

Purchase Order:

Sponsoring Company Name & Address (if different from above):

* Telephone:

Fax:

* Email Address:

Please send the invoice via postal mail, instead of email.

HOTEL RESERVATION

Oil Spill Response has secured competitive rates for hotels in Southampton and Singapore. Hotel reservations must be made via Oil Spill Response in order to enjoy these rates.

Please arrange hotel accomodation for me.

* Arrival Date:	- -
* Departure Date:	- -

I do not require hotel accomodation.

AUTHORISATION OF SPONSORING ORGANISATION

I authorise this booking and agree to abide by the Terms & Conditions.

*Name:

* Date:

- -

VERIFICATION IMAGE

Please key in the code according to the image for verification

* Denotes compulsory

I confirm that the particulars provided above are correct