Emerson Educational Services - Enrollment Request Form

Course Quotation and Enrolment Request: Australia/New Zealand Courses
Process Systems & Solutions

We need to prepare a quotation for every training enrolment. The information we will need for the quotation is in Part A of this form. You can use Part A to request a Quotation for a number of people. Then, all we will need is a Purchase Order or Credit Card payment to complete the enrolment - you will not need to return to this site.

If you already have a quotation and are making an enrolment based on it, please fill in Part A and Part B.

Part A - Request for Quotation Required to Process an Enrolment

We will send you a Quotation from the information you enter in Part A. When you have a Purchase Order matching this Quotation, please e-mail it as directed in the Quotation.

An alternative to sending us a Purchase Order is to pay by Credit Card.

Acceptable credit cards include: Visa, Mastercard and American Express. All cards can be processed in AUD only. AMEX has a 4% surcharge. We value your business and the trust you have placed in Emerson. We take the protection of our customers information very seriously. Due to the inherent risks associated with the internet and as part of our ongoing commitment to our customers, we are informing our customer NOT to email their credit card information. There are many risks with sending personal information, especially through the internet. Please feel free to contact us at +61 3 9721 0200 to provide your credit card information and Quotation Number or if you have any questions or concerns.

* Indicates required field

* Available Courses

* Preferred Course Date
* Preferred Location

Contact Information:

Student Name:

* Full First Name		* Full Last Name
* Nationality

* Job Title

* Phone

* Fax

* Email

Company Information:

* Name

* Address

* City

* State/Province

* Postal Code		* Country

Optional: Please enter additional student names to be added to the quotation:
	Full First Name	Full Last Name	Nationality
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3.
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5.
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8.

As a wholly owned subsidiary of a US company, the products, services and technology that we provide are licensed for Export by the BIS (Bureau of Industry and Security), and as such, we are required to determine the end user, end use and final destination of the products, services and technology. As many of our products contain technology or materials that are controlled, there are limitations on to whom and where the products can be supplied. As such, by determining the final destination, end user and end use, we can carry out the necessary checks to ensure that the supply is with the determined license. We will also screen the end user / end use against a global restricted party list, which is list supported and updated by a number of countries and organizations around the globe, including but not limited to, the DTI in the UK, Japanese Government Gray list for Nuclear and WMD proliferation, Australian Government, UN etc. Nationality is defined by the passport(s) that you hold or could hold.

Please list any special dietary requirements:

Additional Comments:

Part B – Enrolment information

If you have the following information, please enter it and we will be able to complete an enrolment for you with little delay:

Emerson Process Management Quotation Number:

Your Company Purchase Order Number:
(Not required if paying by credit card)

If you do enter a Purchase Order, please e-mail a PDF file of it to [email protected]

Export Compliance:

The acceptance of this enrolment and the fulfillment of any contractual obligations as a consequence of the enrolment is subject to all current applicable import, export control and sanctions, laws, regulations, orders and requirements, including those of the United States where applicable. However, such laws and regulations may be amended from time to time including during the processing of an enrolment. If Emerson Process Management (The Company) should fail to receive any necessary or advisable licenses, authorizations or approvals, even arising from inaction by any relevant government authority, or if any such licenses, authorizations or approvals are denied or revoked, or if there is a change in any applicable laws, regulations, orders or requirements that would prohibit the Company from fulfilling any enrolment, or would in the reasonable judgment of the Company otherwise expose the Company to a risk or liability under such laws, regulations, orders or requirements if it fulfilled the enrolment, the Company shall be relieved without penalty of all obligations with respect to this enrolment.

Further enquiries about Courses, please contact:
Emerson Process Management – Educational Services, Australia and New Zealand

John Atkins
Training Manager
Phone +61 3 9721 0200
Fax +61 3 9720 6614
Email: [email protected]

Consider It Solved.