Continuing Professional Development Enrolment Form

Continuing Professional Development Enrolment Form

This form must be completed and returned to Education In Building for us to confirm your participation in any of the CPD programs. Enrolmentsare to be sent to:

Email:

or

Post: Education In Building

96A Trudy crescent

Cornubia

QLD 4130

CPDEnrolment

Please tick and supply information where required.

Student Details
Title: (Mr Mrs)
First Name:
Middle Name:
Surname:
DOB: DD/MM/YYYY / /
Home Address:
Suburb:
State: / Postcode:
PostalAddress:
(if different)
Contact Telephone No:
Email:
Gender: / Male: / Female:
CPD Course being enrolled in
Please choose any of the following CPD Courses
Course Suite / CPD Points / COST / Select
Mastermind – Tech notes / 1 / $25
Mastermind – Impact / 1 / $25
Mastermind – Default / 1 / $25
Masterclass I / 6 / $220
Masterclass II / 5 / $175
Masterclass III / 3 / $90
Software
Please indicate which software you use.
AccuRate Sustainability
BersPro
FirstRate5
Payment
Please charge the COURSE FEE of______(GST free) to my:
Bankcard / MasterCard / Visa
Card number
Card Expires / / / CRV / (last three digits on back of the card)
Name on the card
Proof Of Identification
Please provide one of the following with this enrolment as proof of your identification.
Drivers Licence
Medicare Card
Australian Passport
Visa (with Non-Australian Passport) for International Students
Birth Certificate (Australian) * please note a Birth Certificate extract is not sufficient
Certificate of Registration by Descent
Citizenship Certificate
Cultural diversity language
Where you born in Australia? / Yes / No
If no, which country where you born?
Are you of Aboriginal or Torres Strait Islander Origin? / Yes / No
Are you a Permanent Resident of Australia / Yes / No
Is English the main language spoken within your home? / Yes / No
If no, please state the main language spoken within the home
Please rate your proficiency in the English language (please tick)
High
Average
Poor
Will you be requesting help with ‘English’ in your studies? / Yes / No
Do you consider yourself to have a permanent disability, impairment or a long-term condition?
Vision
Hearing
Physical
Learning
Medical Condition
Mental Illness
Other
No- Not Applicable
Assessor Accrediting Organisation
Please tick  where required.
Which is your assessor accrediting organisation?
Building Designers Association (BDAV)
Australian Building Sustainability Association (ABSA)

Privacy Notice

Under its national reporting obligations,EIB is required to supply information collected on this form to State or Federal Government agencies for purposes of research, statistics and program evaluations.

Information we collect is used only for the purpose stipulated at the time that the information is collected. EIB is required by law not to reveal, disclose, sell, distribute, rent, licence, share or pass on to any third parties, any personal information that you may have provided us unless we have your express consent to do so.

By signing this form and attesting to the validity of the information supplied, you are agreeing to the supply of this information for the stated purposes. No other disclosure will be made without your consent except as authorised or required by law. You have on requesta right of access to personal information we hold about you.

Student Acknowledgement

I acknowledge that I have read all the above information and I confirm that all the details that I have provided are true and correct.
In completing this form, you are agreeing to Education In Building Terms & Conditions - See website for details
Print Name
Signature
Date / /

CPD EnrolmentForm Page 1