Online booking for e-learning health and safety courses from discovery consultancy

Discovery Consultancy Ltd course enrolment form for the NEBOSH National General Certificate.

Please complete the form below and submit it to apply for registration.

Alternatively you can download the form in .doc or .pdf format, please click on the version you would prefer to use.

Click here to download the .DOC version, when prompted please SAVE the file to your computer.

Click here to download the .PDF version (requires Adobe Acrobat)

1. Personal Details

Title

Please complete if you have selected "other" from above

Gender:

Male Female

Surname:

Forename(s):

Address:

Postcode:

Date of Birth:

/ /
(Format: dd/mm/yyyy)

Email Address:

Telephone No:
(work)

Mobile Phone:

Company:

2. Course Structure

The course can be undertaken in one of two modes – either as consecutive units (NGC1 immediately followed by NGC2) or as separate units (attend NGC1 of one course followed by NGC2 of a later course). NGC1 and NGC2 studies lead to the written examinations (“The Management of Safety and Health” and “Controlling Workplace Hazards”) respectively. Assessment of NGC3 (“Health and Safety Practical Application”) is normally completed within the NGC2 study period but must be taken within 14 days of the completion of NGC2.

Please indicate at ‘3.’ which mode of attendance you prefer.

Details of course and examination dates can be viewed here.

3. Study Format

Consecutive Units

Separate Units

Exam Date

NGC1 start date:

(dd/mm/yyyy)

NGC2/3 start date:

(dd/mm/yyyy)

4. Referred or Re-registering Candidates

Please complete this section only if you are either

a referred candidate for one or two units (NGC1; NGC2; or NGC3)
a previously failed candidate re-registering for examinations only for all three units.

Details	Paper NGC1	Paper NGC2	Practical Assessment
Date of previous examination	(dd/mm/yyyy)	(dd/mm/yyyy)	(dd/mm/yyyy)
Preferred Exam or Assessment Date	(dd/mm/yyyy)	(dd/mm/yyyy)	(dd/mm/yyyy)
Previous Candidate Number (to qualify as a referred candidate)	C.

5. Course Costs (GBP)

Fee Element	Course Fee	VAT	NEBOSH Registration Fee	Total Payable
Full Course (NGC1-3)	1250.00	218.75	90.00	1558.75
Referral - 1 Unit	40.00	Incl	45.00	85.00
Referral - 2 Units	85.00	Incl	90.00	175.00
Re-registration	85.00	Incl	90.00	175.00

6. Payment

To confirm my place on the course, I will do one of the following: (Please tick the relevant method of payment)

1. Send (recorded delivery) a cheque made payable to Discovery Consultancy Ltd

2. Send a Bankers Draft from Bank
** (Please ensure you also enter the name of the bank the Draft is being sent form)

3. Call you to arrange an electronic transfer

7. Booking and Cancellation Policy

Please tick this box to confirm that you have read our "Booking and Cancellation Policy" and agree to these terms.

health & safety consultancy \| health & safety training \| why choose us interactive e-learning \| contact us \| resource links \| shop \| home site map \| data protection \| disclaimer \| site credits

Discovery Consultancy Ltd, 23 Landale Gardens, Cupar, Fife, UK, KY15 4UE Health and Safety - Training - Consultancy © Discovery Consultancy 2004. All rights reserved.