Enrolment In: 2024 ON-ROAD DEFENSIVE DRIVER COURSE | ONE ON ONE – BECONSULT SECTION A - ENROLMENT OPTIONSON-ROAD DEFENSIVE DRIVER COURSE | ONE ON ONE* Price: SECTION B - PREVIOUS APPLICATIONS AND/OR ENROLMENTSHave you previously applied to, or been enrolled at Intelligent Training Solutions?*NOYESIf Yes, please state your I.T.S Student ID number (If known) example: ITS000123XHas your name changed since your last enrolment with us?NOYESIf Yes, you must provide documentary evidence (Marriage Certificate etc...)If Yes, please enter your previous name Please enter your previous FULL legal nameSECTION C - PERSONAL DETAILSTitleMrMrsMsMissDrUnspecifiedFirst name* Enter your first legal given nameMiddle Name Family name (surname)* Enter your legal family name (surname)Date of birth* DD slash MM slash YYYY Select your date of birth using the calendar to avoid formatting errorsCONTACT DETAILSIf possible, PLEASE provide us with BOTH your home (landline) and mobile numbers. As this course requires the coordination of yourself and a driver trainer, it may become important for our team to contact you should the need arise. Telephone: HomeTelephone: Mobile*Your preferred email address* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please provide the physical address of where you usually reside - street number and name, not post office box. Do not provide any temporary address at which you reside for training, work or other purposes. If you are from a rural area, use the address from your state or territory's rural addressing or numbering system as your residential street. Is your mailing address the same as your residential address?* YES NO Please enter your mailing address below. Please enter your mailing address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country NOTE: This will be the address our team will send out your Certificate should you choose to have a printed copy sent to you SECTION D - EMERGENCY CONTACT DETAILSThis course contains practical on-road training, therefore we require the contact details of your preferred emergency contact person. Please ensure that the person you nominate here is aware of your medical hisotry. Who would you like us to contact in the unlikely event of an emergency? TitleMrMrsMsMIssDrUnspecifiedFirst Name* Family Name (Surname)* Telephone: Mobile*Telephone: OtherRelationship: How this is person related to you?* SECTION E - NOMINATE A THIRD PARTY TO PAY FOR THIS COURSEIs this course being paid for by a third party such as an employer, school, employment agency or other organisation?* YES If Yes, please complete the details below Organisation Name - BECONSULT SECTION F - NOMINATE YOUR PREFERRED COURSE DATE AND TIMEPlease provide us with at least three (3) preferred dates and times with which you can participate in this course. PLEASE NOTE: Our team will do their best to accommodate your preferences above, however, Intelligent Training Solutions CANNOT guarantee your preferences. You will be contacted by one of our team members shortly confirming our trainer's availability for your course. 1st Preference | Date* DD slash MM slash YYYY 2nd Preference | Date* DD slash MM slash YYYY 3rd Preference | Date* DD slash MM slash YYYY What time of the day would you prefer to complete this course?*AMPMSECTION G - DRIVERS LICENCE REQUIREMENTSDo you drive a manual or automatic vehicle?* Select All Manual (Gears) Automatic PLEASE NOTE: All defensive driver courses are conducted in automatic vehicles supplied by Intelligent Training Solutions. Intelligent Training Solutions does not offer manual defensive driver courses UNLESS specifically requested to do so. Additional fees will apply for manual defensive driver courses. For manual courses, please call our office on 03 5415 0204 directly after or prior to completing this enrolment form.Do you hold a current and valid Australian Drivers Licence or Learner Permit?* YES NO Has your Australian Drivers Licence or Learner Permit been recently cancelled or suspended OR is scheduled to be cancelled or suspended?* YES NO If your licence or learner permit has been suspended or cancelled, you cannot enrol into this course. If your driver's licence or learner's permit is pending suspension, please ensure that your licence will still be active prior to attending this course. IMPORTANT NOTE: Failure to attend this course with a valid, current driver's licence or learner's permit will result in your trainer cancelling this course on the day. If we need to cancel your course due to you not having a valid licence or permit, you will be liable for the full cost of this course. No refunds are issued to participants who attend a defensive driving course without a valid drivers licence!SECTION H - TERMS AND CONDITIONS & STUDENT DECLARATIONPlease take a moment to review our standard enrolment terms and conditions by clicking the following link: Enrolment Terms and ConditionsPLEASE NOTE:TO SUBMIT THIS ENROLMENT FORM, YOU MUST AGREE TO ALL THE TERMS AND CONDITIONS LISTED BELOW & SIGN YOUR NAME WHEN PROMPTED. STUDENT DECLARATION* I declare that the information I have provided, to the best of my knowledge, is true and correct. I understand the terms and conditions of this written agreement, including the refund procedures. I have understand the fees and refund conditions of my enrolment and agree to be a student of Intelligent Training Solutions Pty Ltd. I agree to pay all the fees and charges listed on this enrolment form. I understand that if I nominate a third part to make payment for this enrolment, I remain liable for all enrolment fees until such time as the nominated third party has settled the account. I understand that I must give I.T.S 7-days notice if I cannot attend this course. Should I fail to provide 7-days notice, I understand that I am liable and must pay the FULL course fees. Failure to do so will result in my account being sent to a debt collection agency. I have made my own enquiries and believe that this training course is suitable for my personal and/or career purposes. I consider that, based on my educational attainment, capabilities, aspirations and interests, this training is appropriate for me. You must tick all the boxes above to be presented with the 'SUBMIT YOUR ENROLMENT' button. If you have any concerns about our terms and conditions, please contact our office on 03 5415 0204 during business hoursSTUDENT SIGNATURE*PAYMENT DETAILSYOUR PREFERRED PAYMENT METHOD*PAY ON INVOICETOTAL ENROLMENT FEE $ 0.00 CommentsThis field is for validation purposes and should be left unchanged.
