Course Enrolment Form

Office Use Only

Original EOI sighted
_{___________}

Type of EOI document sighted showing current
address: _{______________________________________}

Certificate Number: _{______________________________}

Marine Training Services
17 Swanston Street Geelong Vic 3220 Tel: 03 5229 5432
Marine Licence Training Course - Student Enrolment Form
* Indicates required field

* Family Name:	* Date of Birth:
* Given Name/s:	Sex:	Male Female
* Current Address:	Phone:
* Suburb:	Mobile:
* Post Code:	*Email:
(You must provide evidence of residence where your current address is not shown or is different to the address shown on your evidence of identity document/s)

Course Title	Marine Licence Training	Course Venue
Course Title	and/or Personal Watercraft (PWC) Endorsement	Course Date

Photo Driver Licence/Photo Learner Permit Number:

IF THE ABOVE IS NOT HELD TWO FORMS OF EVIDENCE ARE REQUIRED

Evidence of Identity	Type of ID	ID Number
Primary
Secondary

We need to sight your ID otherwise we are not authorised to issue the Marine Safety Victoria Certificate required by Vic Roads.

Under the Privacy Act, the individual's registration details stated on this form will only be used for issuing a training certificate for the purpose of applying for a Victorian Marine Licence. However, Marine Safety Victoria have requested the phone and email details of course participants. (Please read the full MTS Privacy Statement)

At the time of enrolment participants should be aware of eligibility requirements for course enrolment and details of Marine Licence in-eligibility. Click here to view or download the legibility document.

Do you give your permission for Marine Training Services to contact you by phone for course improvement purposes?	Yes No
Do you give your permission for the training provider to supply Marine Safety Victoria with your phone and email details?	Yes No
Do you have any concerns regarding your language, literacy & numeracy skills?	Yes No

Student Signature ____________________________________ (To be signed in class)

Date________________________________ (To be dated in class)

Outline of refunds if paid in advance
Withdrawal prior to agreed start date	Full refund
Withdrawal after the agreed start date and prior to course completion	50% refund
Course withdrawn by Marine Training Services (MTS)	Full refund
MTS is unable to provide the course for which the original enrolment and payment has been made	Full refund