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CPD Course Register Form

Course Name: *
Provider: *
Course Description:
When is the course being held?:
Flyer / Agenda / Documentation:
Course Duration:
Days: Hours:
Where is the course being held?
Australia Wide
Adelaide
Brisbane
Canberra
Darwin
Hobart
Melbourne
Perth
Sydney
Regional NSW
Regional NT
Regional QLD
Regional SA
Regional TAS
Regional VIC
Regional WA
N/A - Online Program
Other
Please complete if other:
Method to Verify Attendance:
Marked Attendance List   Scanned Barcode   Other  
If other, please specify:
Assessment Description:  *
Venue:
Who is presenting the course? *
What are their qualifications?  *
Mode of Delivery:
eLearning   Seminar/Workshop   Convention/Conference  
Learning Objectives and Outcomes:  *
I want NIBA to display my course on the NIBA College Calendar ($49.95) : Yes  No
Available To:
Private (in house/invitation only)   Public  
Contact Details (displayed on CPD Register)
Contact Name:
Email:
Phone:
Website:
Registration Form:
Company Details (not displayed)
Company Name: *
Legal Name: *
ABN: *
Company Address:  *
Contact Name: *
Phone:
Email: *
* Indicates a mandatory field.