Trainee Name

First Name

Last Name

Preferred name

Your First name or the name you are usually known as

Instructor

Please enter your instructor's name

I am enrolled in intake/seminar

I apply to

Intake to which I wish to transfer

My reason for this application

Please give your reason for this request

Terms

In submitting this form electronically I have agreed to the provisions stated on this page and understand that I will be invoiced in accordance with the published fee schedule. Fees Payable Information on other fees can be found here. You undertake to pay all fees as they become due and to meet any late fees and collection charges associated with debt recovery. Credit card surcharges apply to all payments made by credit card.

Declaration

I declare that to the best of my knowledge all the information supplied on, and with, this form is true and complete. I consent to the disclosure of personal information and I undertake to pay fees and comply with the IPLS regulations and policies as described above. This Application Form covers Regulations 4(4), 4(7), 12, 13, 16, 17, 18, 19, 21

Agreement

I agree to the conditions above

I do not agree to the conditions above

Supporting Documents Section

NOTE: Supporting documents should be emailed separately to tuaform@ipls.org.nz as soon as possible