Help for Registration/Purchase Form


'District' applies only if your address is rural.


State your profession here. Examples:

·     Nurse

·     Psychologist

·     Social Worker

·     Counsellor

·     Occupational Therapist

·     Teacher

·     General Medical Practitioner / Psychiatrist / other specialist etc.

Professional Assn:

To what professional organization(s) do you belong? Please type the abbreviation typically used, then (in brackets) the full name. Examples:

·     ANZASW (Aotearoa New Zealand Association of Social Workers)

·     NZPsS) (New Zealand Psychological Society)

·     etc.


Current Position:

This refers to the role you currently occupy. Examples:

·     Ward Manager

·     Private Practitioner

·     Team Leader, Mental Health

·     Corrections Officer

·     etc.


Send Invoice for payment to:

Provide instructions as to how the invoice is to be addressed. Include the following information:

1.     The name of the individual or organisation who is paying

2.     Their postal address

3.     Their email address (most invoices are e-mailed)

Here are several examples:

·     If you are paying and your details are the same as you have already provided, simply type:


·     If an organization is paying, enter the details something like the following example Note: to begin a new line in the text box, press ENTER on your computer's keyboard):

Waikikamucau District Health Board
Mary Smith, Accounts Manager
Waikikamucau District Health Board
PO Box
Waikikamucau, 26549

mary_smith@ waikikamucau


How I heard about these resources:

Please tell us briefly how you became aware of the resource you are requesting. Examples:

·     Internet search

·     Colleague told me

·     Advert in X Journal

·     Advert on noticeboard at work

·     etc.


Additional Information for Simulator purchase

NB: this option is only for existing Certificate holders who trained before the Simulator was available (if you are enrolling for a current course which uses the Simulator, it will already be included).

Please provide the following  information:

·     Your name exactly as it appears on the Certificate

·     Certificate type: (eg. Primary, Advanced, Associate Fellow, Fellow,  Diploma)

·     Certificate issued by

·     Year of issue