Participant details
First name: *

Last name: *

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Mobile: *

Email: *

School/Organisation details
School/Organisation: *

Address: *

Suburb/City: *

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Postcode: *

Phone: *

Purchase order no.: (if at a school, please obtain from accounts dept.)

Course details
Course: *

Venue: *

Date from: *

Date to: *

For re-accreditation courses, please enter the same date in both fields.

Re-accreditation (only)
Date of last training:

Location of last training:

IF MORE THAN FIVE YEARS HAVE PASSED SINCE PREVIOUSLY ACHIEVING ACCREDITATION: Participants will be asked after registering to demonstrate that they have been involved in bicycle education programs in an ongoing way since previously achieving accreditation, in order to be enrolled in a re-accreditation course. This is in accordance with Victorian Department of Education and Training guidelines.

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