Registration Public Course Registration CIMS 3 / CIMS 4 Course Name*Date*Liaison Person*First Name*Last Name*Mobile Phone*Email* TitleMr.Ms.Miss.Mrs.Mx.Dr.Workplace*Role*Workplace Address* Street Address Address Line 2 Region ZIP / Postal Code Please confirm if you would like to be assessed for NZQA Unit Standard*YesNoI need more informationFor CIMS 4 please confirm: have you previously completed CIMS 2 or CIMS 3?**Please select n/a if registering for CIMS 3.* A requirement of completing CIMS 4 is completion of CIMS 3. YesNon/a Registering for CIMS 2What organisation did you complete the CIMS 2 or CIMS 3 training with?**If you are registering for CIMS 3, then please write n/a*NZQA IDIf you would like to be assessed against unit standards please enter your NZQA ID. Please note that US 29553 is a pre-requisite for US 29554 (CIMS 4).Do you have any special dietary requests?*Terms and Conditions Once we have confirmed your place on the course payment will be required. Please ensure that your HR department or the person who will be responsible for payment of the invoice is aware of this. If you are unable to attend, a substitute can be sent in your place. Payment is required prior to the course. * I agree to the above Terms & Conditions NameThis field is for validation purposes and should be left unchanged.