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[{ "fldName" : "USER_FirstName", "label" : "First Name"},{ "fldName" : "USER_LastName", "label" : "Last Name"},{ "fldName" : "USER_EmailAddress", "label" : "Email Address"},{ "fldName" : "USER_EmailAddress_Confirm", "label" : "Confirm Email Address"},{ "fldName" : "USER_Password", "label" : "Password"},{ "fldName" : "USER_PasswordConfirm", "label" : "Confirm Password"},{ "fldName" : "USER_CompanyName", "label" : "Company Name"},{ "fldName" : "USER_CompanyAddress", "label" : "Company's Address"},{ "fldName" : "USER_CompanySuburb", "label" : "Company's Suburb"},{ "fldName" : "USER_CompanyState", "label" : "Company's State", "labelConfig" : "CompanyStatePO"},{ "fldName" : "USER_CompanyPostCode", "label" : "Company's Post Code", "labelConfig" : "CompanyStatePO"},{ "fldName" : "cbProfileType", "label" : "Your Profile section", "fldSearchString" : "input[type=checkbox][name*=\'cbProfileType\']"},{ "labelClub" : "CompanyStatePO", "fldNames" : "USER_CompanyState~USER_CompanyPostCode"}]USER

Personal Details

First Name:
Last Name:
Middle Name:
Email Address:
Confirm Email Address:
Password must be between 4 - 8 characters, including at least one number
Confirm Password:
Company Name
Address Line 1:
Address Line 2:
State & Post Code:
To help us determine what access you require, please select from the following all that apply
Clearance Issuer - I need to be able to issue WPCG Clearance Forms so that I can perform low risk work at service stations and fuel depots.
and one of the following

Company Trainer :
Choose Company first
Company Admin - I do not need the WPCG accreditation, I only need to be able to monitor the accreditation status for personnel in my organisation.
Privacy :
I do not allow WPCG to publish my name and company details on the WPCG website.
Prior to continuing, please download the following information on Licenced Training Providers (JulSen to provide link to LTP agreement). You will need to submit a signed copy of the LTP Agreement along with your submission.

You MUST fill in below asked information, failure to complete the form as required will result in delay for your registration.
Name & Address of all Branches to be included in this agreement:
Branch NameStreet No. & NameSuburbStatePost Code
Copy of Company Policies, Standards, Procedures that outline how your company maintains high quality training and assessment practices
Copy of signed Licenced Training Provider Agreement
Refer to the Licenced Training Provider Agreement, section 4.5 for LTP trainer requirements.

Section A

Attach a copy of your Certificate IV in Training & Assessment

Course Code:
Course Date:
Delivered By:
Upload a copy of your qualifications and any other supporting documentation here

Section B

Outline your Training experience - Fill in relevant sections only.
Type of Training Delivered:
Where Training delivered (eg classroom, on the job):
Training Aids utilized (eg powerpoint. demonstration):
What is the average duration of courses you present:
How many years have you been a Trainer:
How many people have you trained:
Attach a copy of a training course you have delivered, or any other supporting evidence

Section C

Years of experience in downstream petroleum or similar industry which also deals with flammable or combustible materials (minimum 5 years is required)
Years of experience: