Eastcoast Fireworks Terms and Conditions of Trade
You must complete every section of this form. Once we receive your application, we will be in touch by email.
Course DetailsCourse Name / Trainee Pyrotechnician (Fireworks) Certification Course
Address / Eastcoast Fireworks, 56 Mill Street, Ongaonga, Central Hawke’s Bay
Date of Part A / Saturday 2ndSeptember 2017 / Time / 0900 – 2130 Hours
Date of Part B / Saturday 9th September 2017 / Time / 0900 – 2130 Hours
Applicants Details
First Name
Middle Name
Last Name
Drivers Licence Nº / Date of Birth
Street Name
Suburb Town/City / Post Code
Home Phone / Cell Phone
Emergency Contact Details
Full Name
Relationship to you
Home Phone / Cell Phone
Business Details
Authorised Contact Person
Company Name
Postal Address
City/Town / Post Code
Work Phone / Cell Phone
Course Fees and Arrangements– The course fee is $1200.00 GST Inc. per person. This course application form must be accompanied by a $600 non-returnable deposit at the time of booking to secure your spot, with the balance of $600 payable 2 weeks prior to the course.Payment MUST be received in FULL prior to the course date. Payment will not be accepted on site, or after the course date. The course is subject to cancellation if we do not reach minimum number of attendees.
Confirmation- A confirmation email will be sent out to confirming your place on the course on receipt of full payment.
How to pay your course fees - You can make payment into the Eastcoast Fireworks bank account in the following ways:
- Telebanking/Internet Banking - Please return your signed “Enrolment Form” by email to then make arrangements to deposit by Telebanking/Internet Banking into the following bank account:
Account Name: / Eastcoast Fireworks
Account Number: / 03-1509-0062102-000
Payment Particulars: / Your Name
Payment Reference: / Pyro0917
- Cheque – Make a cheque payable to the Eastcoast Fireworks for the course fee and post with the cheque along with your signed Enrolment Form to Eastcoast Fireworks, P.O. Box 55, Ongaonga, 4244.
- PayPal - Please contact us. You will be sent an email containing instructions for paying your course fee by credit card online, directly into the Eastcoast Fireworks bank account. A 2.05% credit card surcharge applies to all payments made by credit card. You will still need to complete and return your signed Enrolment Form by email to
- Organisation/Company Paying - Please attach a letter or purchase order number from the organisation/company confirming payment of your fees. If for any reason the organisation/company does not pay your fees you are still liable for all fees invoiced to you. You will still need to complete and return your signed Enrolment Form by email to
Declaration - By signing below, I declare that: (a) I have read and understood the information in this form and the Eastcoast Fireworks Terms, Conditions and Health and Safety information posted on the website before completing this form; (b) I undertake to follow all the safety regulations and understand my obligations to assist in maintaining a safe working environment; (c) I warrant that I will participate in the fireworks and safety training at my own risk; (d) to the best of my knowledge and belief I am physically fit and there is no other medical condition or disability likely to prevent me from completing the training I intend to undertake; (e) to the extent permitted by law, I waive, release and discharge Eastcoast Fireworks (Rural Fire Service Ltd) personnel and volunteers from all claims, proceedings, losses, damages, liabilities (including negligence) and the like arising out of or in any way in connection with my participation in the fireworks and safety training; (f) I undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery; (g)I make all of the declarations, warranties and acknowledgments set out on my own behalf.
Applicants Signature / DatePlease return this form by email to
© Eastcoast Fireworks - P.O. Box 55, Ongaonga, 4244 丨06 856 6091 丨021 712 180丨丨丨Page 1 of 2