Water Safety Awareness Course Registration Form

Please Note

This form should be completed at least 14 days in advance of the start date of a Water Safety Awareness course. Fee: €32 per participant

E-Certificates will not be issued until all invoices pertaining to courses are paid.

Water Safety Awareness Course Details

Name of WSI Approved Provider(s) *

Provider(s) confirmHold Current MembershipHolds WSI Insurance

Type of Course (please tick one)GeneralGeneral & Pool

Site SpecificBeachRivers/Streams/Fast WaterWater Supply/Pumping Stations/ReservoirsOther

Please Specify Site Specific

Proposed start date

Proposed end date

Venue

Number of candidates

Number of Manuals required

Manuals Shipping Name

Address

Phone Number

Email Address *

Billing Name

Address

Phone Number

Email Address *

Purchase Order Number

Number of Theory Hours

(Alternatively Upload your Signature)

No file chosen