Loddon Plains Landcare Network Chemical Users and 1080 course, Kerang

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This form is an Expression of Interest to undertake a Chemical Users training course. The course will be delivered by a registered organisation and allow participants to apply for an Agricultural Chemical Users Permit with 1080 extension.
You will need to supply all information in order to secure your Expression of Interest.

Any questions can be directed to Danny Pettingill, Loddon Plains Landcare Network Project Officer;
0490 412 430
facilitator@lpln.org

Do you live in the Kerang area? *

Yes

If you are not from the above area, please tell us where you are located.

Do you have a current Agricultural Chemical User Permit (ACUP)? *

Yes

Maybe

Please select the qualification you are interested in obtaining in the courses offered *

Chemical Handling and 1080 extension - in order to obtain Agricultural Chemical Users permit with 1080 extension

1080 extension only - Chemical Handling and Agricultural Users Permit required prior to undertaking this extension.

Refresher to above only

Will you be able to attend all days required to complete the course? *

3 day course - Chemical Handling and 1080 extension

1 day course - 1080 extension only

1 day course - refresher only

Chemical Handling Registration (Aus Chem) number

If you have already completed your Chemical Handling training and are registering for the refresher or 1080 increment, please supply your Chemical Handling Registration (Aus Chem) number. You can find this on your certificate of completion. If you can't supply it here, please email it or bring it along on the day. If you have a current ACUP, skip this question and provide that number in the next section.

Chemical Handling Registration (Aus Chem) number

If you already have an ACUP, please supply the number below. This can be found on your card in the top right corner.

Are you able to pay a small fee for catering and other costs? 3 day course $150, 1 day 1080 or refresher $100 *

Yes

Are you available to complete this training on the 10th to 12th of February 2020? *

Yes

To undertake this training you will need to supply a USI number

This USI number is required for all training and qualifications. You can obtain a number via this link https://www.usi.gov.au/your-usi/create-usi

To secure your place on this training, you will need to provide this number.

Do you have a current USI? *

Yes

If you already know your USI, please supply it below

How did you find out about this course? *

Please provide your details for contact and administration

Full name *

Best contact number *

email *

Thanks, someone will be in touch shortly. Any questions should be directed to Danny Pettingill 0409 412 430 or facilitator@lpln.org

This project is supported through funds from North Central CMA

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