Loddon Plains Landcare Network Chemical Users and 1080 course, Kerang
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? *
If you are not from the above area, please tell us where you are located.
Your answer
Do you have a current Agricultural Chemical User Permit (ACUP)? *
Please select the qualification you are interested in obtaining in the courses offered *
Will you be able to attend all days required to complete the course? *
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
Your answer
If you already have an ACUP, please supply the number below. This can be found on your card in the top right corner.
Your answer
Are you able to pay a small fee for catering and other costs? 3 day course $150, 1 day 1080 or refresher $100 *
Are you available to complete this training on the 10th to 12th of February 2020? *
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? *
If you already know your USI, please supply it below
Your answer
How did you find out about this course? *
Your answer
Please provide your details for contact and administration
Full name *
Your answer
Best contact number *
Your answer
email *
Your answer
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
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy