Office Use Only Original EOI sighted

Type of EOI document sighted showing current
address: ______________________________________

  Certificate Number: ______________________________

Marine Training Services
17 Swanston Street  Geelong  Vic  3220  Tel: 03 5229 5432  
Marine Licence Training Course - Student Enrolment Form
* Indicates required field
* Family Name: * Date of Birth:
* Given Name/s: Sex:  
   Male      Female
* Current Address: Phone:  
* Suburb: Mobile:  
* Post Code:


(You must provide evidence of residence where your current address is not shown or is different to the address shown on your evidence of identity document/s)

Course Title Marine Licence Training * Course Venue
and/or Personal Watercraft (PWC) Endorsement * Course Date

Photo Driver Licence/Photo Learner Permit Number:
Evidence of Identity Type of ID ID Number

We need to sight your ID otherwise we are not authorised to issue the Marine Safety Victoria Certificate required by Vic Roads.

Under the Privacy Act, the individual's registration details stated on this form will only be used for issuing a training certificate for the purpose of applying for a Victorian Marine Licence. However, Marine Safety Victoria have requested the phone and email details of course participants. (Please read the full MTS Privacy Statement)

At the time of enrolment participants should be aware of eligibility requirements for course enrolment and details of Marine Licence in-eligibility. Click here to view or download the legibility document.

Do you give your permission for Marine Training Services to contact you by phone for course improvement purposes?
Do you give your permission for the training provider to supply Marine Safety Victoria with your phone and email details?
Do you have any concerns regarding your language, literacy & numeracy skills?
Student Signature   ____________________________________                                                                       (To be signed in class) Date________________________________                          (To be dated in class)
Outline of refunds if paid in advance
Withdrawal prior to agreed start date Full refund
Withdrawal after the agreed start date and prior to course completion 50% refund
Course withdrawn by Marine Training Services (MTS) Full refund
MTS is unable to provide the course for which the original enrolment and payment has been made Full refund