NZIHT Short Course Application

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New Zealand School of Engineering, Energy and Infrastructure

NZIHT Short Course Application

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NZIHT Course(s)

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Personal Information

Legal First Names *

Your first name is required.

Legal Surname *

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Preferred First Name *

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Previous Names (if any)

Gender *

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Email Address *

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Date of Birth *

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Postal Address

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Mobile *

Phone

Citizenship

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Ethnicity

What ethnic group do you belong to? *

Ethnicity: *

Iwi Option One:

Iwi Option Two (If applicable):

Iwi Option Three (If applicable):

Iwi Option Four (If applicable):

Iwi Option Five (If applicable):

Iwi Option Six (If applicable):

Hapū:

Fees

How do you intend to pay your fees?

Is an organisation or company paying your fees?

If for any reason the organisation/company does not pay your fees, you will be liable for the full payment

Purchase Order Number

Please generate your purchase order number under the company name WITT.

Organisation/Company Name *

Authorised Contact Person *

Street Number and Name*

Suburb

City *

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Contact Person Email *

I have read the Declaration and agree to its terms and conditions *

Terms and conditions must be agreed to.