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Affiliate of

Cert No. 6157 ISO 9001

Student Registration Form (NEBOSH Course) Student ID (to be filled after registering with NEBOSH or if you have been registered in the past):

COURSE (IOGC/IGC/ICC) Course Fees (Includes registration fee) All fees are in Canadian Dollars plus GST @ 5%

IGC - $3875 ☐ IO&GC - $2875 ☐ ICC - $4500 ☐ IFC - $4500 ☐

Course Location and/ or Country Course Start Date Exam Date Title (Mr/ Mrs/ Ms/ Dr)* First Name (as per passport)** Surname (as per passport)** Date of Birth* Nationality* Provide Postal Address*, Email* and Contact Details below:

Door Number, House Name Street City/ Town County Post/Zip code Telephone (Home) Telephone (Mobile) Telephone (Work) Email* TUITITION INFORMATION

Payment Details (Include Invoice or Purchase Order number and date) Any other details relevant

* Mandatory to fill-in details.

OPS ATLAS INC Suite 3300 205 – 5th Avenue SW Calgary, Alberta, Canada, T2P 2V7

** Please attach scanned copy of passport (including photo page).

Tel : 403-705-8561 Fax : 888-334-4927


Affiliate of

Cert No. 6157 ISO 9001

Credit Card Payment I, ________________________, authorize OPS Pacific to use the credit card indicated on this form for the (purchase order number /invoice number________________. Name on Credit Card

16 Digits of Credit Card 3 Digit CSV Expiry Date

MM

YYYY

Billing Information: Company/Name

Address City / State Zip Code Telephone Number Fax Number

Signature: ____________________________________ Date:

______________, 201

* Bank/Wire Transfer and PayPal payment options are also available upon request

OPS ATLAS INC Suite 3300 205 – 5th Avenue SW Calgary, Alberta, Canada, T2P 2V7

Tel : 403-705-8561 Fax : 888-334-4927


Affiliate of

Cert No. 6157 ISO 9001

Confidentiality Agreement OPS Pacific is an educational facility which handles sensitive student information on a regular basis. In accordance with the Privacy Act and PIPEDA, OPS Pacific requires all employees to handle sensitive personal student information in a confidential and appropriate manner. It is understood that employees of OPS Pacific will become aware of confidential information regarding our staff and students through the course of their employment. Employees agree that if confidential information is not effectively protected, the operations of OPS Pacific may be threatened, and the well-being and privacy of our staff and students may suffer irreparably. Employees of OPS Pacific are required to keep all confidential information and relevant knowledge regarding the facility, our staff and our students confidential both during and after their term of employment. These practices have been adopted as they have been deemed essential to the protection of OPS Pacific, and the well-being and privacy of our staff and students. The following is classed as confidential information. Confidential Information: • Student Lists; • Student educational information (including grades, report cards, reviews, etc.); • Student financial information; • Student personal information; • Information gathered during interviews; • Staff personal information; • Human resource planning, policies or procedures; • Facility financial information, status and statements; • Any information, or documentation labelled “Confidential” by the facility, or listed as such by separate memorandum, or e-mail that informs of confidential status; • Any information pertaining to OPS Pacific’s students, staff, and visitors. Any information relating to the OPS Pacific that is freely in the public domain may not be considered “Confidential”. In the event that an employee can prove that information was possessed before it was received from OPS Pacific, or that information was gained from an unrelated third party, said information will not be classified as “Confidential”. Nondisclosure: Members of, including but not limited to students, contractors or employees, OPS Pacific, shall not divulge, disclose, provide or disseminate Confidential Information to any third party not associated with OPS Pacific at any time, unless OPS Pacific gives written authorization. Furthermore, Confidential Information shall not be used for any purpose other than its reasonable use in the normal performance of study or employment duties for OPS Pacific. This agreement will not supersede any legal obligation to disseminate information when required to do so in a court of law. Acknowledgment and Agreement / Statement of Confidentiality

OPS ATLAS INC Suite 3300 205 – 5th Avenue SW Calgary, Alberta, Canada, T2P 2V7

Tel : 403-705-8561 Fax : 888-334-4927

student-registrarion-form-canada-v-5  
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