Program Registration

Course Registration Form
I am interested in registering to attend the following program:*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
I am over the age of 18 *
Courses offered are not suitable for those under the age of 18 unless specified.
I have previously completed a course through Rebalance Training*
If yes, when?
If registering for a refresher course - when did you last complete a Mental Health First Aid Course?
Would you like to be added to our mailing list where you will receive advance notice about any upcoming courses as well as access to special offers and information.

YesNo
Please note: Following reciept of this form you will be contacted to confirm receipt and to arrange payment. Your booking is not confirmed until payment is cleared. Payment must be cleared prior to the program commencement.
Should be Empty:

Course Registration Form