Training Booking Form

Please complete all relevant sections in BLOCK CAPITALLETTERS, sign the form and send to ECO-UNESCO. Contact details below.

PART 1: PARTICIPANT DETAILS
Individual’s Details / Your Organisation’s Details(if applicable)
First Name: / Name of Organisation:
Last Name:
Home Address: / Organisation Address:
Mobile Phone: / Organisation Phone:
Home Phone: / Organisation/Work Mobile:
Email: / Organisation Email:
Date of Birth: / Organisation Fax:
PPSN (Required for FETAC courses only) / Organisation website:
Emergency Contact Name and Phone number:

Gender: MaleFemalePrefix:Mr Ms Dr

Age:<1010-1415-18 19-2122-2425 or over

PART 2: PROGRAMME REQUESTED (Please tick the course/event you wish to register for)
Education and Training Programmes and Services
Please refer to for a list of our next scheduled short training courses
Please state the date of the course you wish to book for:
Short Courses:
Environment Education: Trends and Developments
Environmental Education Curriculum Links
ECO-CommunityGarden Training
Leadership and Strategic Sustainable Development Training
Youth Work and Sustainability Training
Drug Prevention Training for Trainers (an alternative approach to Drug Prevention)
ECO-Sustainability Award Training
ECO-Watchers one-day Training for teachers and leaders (EPV Approved Training for Teachers)
FETAC Awards Ceremony/Alumni Network meeting
Young Environmentalist Awards 6 Steps To Success
Youth Leadership and ECO Skills
Please state the date of the course you wish to book for:
Accredited Courses:
ECO-UNESCO’s Introduction to Sustainable Development (FETAC Level 5) Intensive 10 week
ECO-UNESCO’s Peer Education for Sustainable Development (FETAC Level 5)
ECO-UNESCO’s ECO-Community Development (FETAC Level 3)
Junior ECO-Watchers EPV Accredited Teacher Training Week (Dept. of Education and Skills)

ECO-UNESCO│The Greenhouse │17 St Andrew Street │Dublin 2

T: +353 1 6625491│F: +353 1 6625493 │E:

Template Version: August 2012Page 1 of 2

PART 3: EDUCATIONAL DETAILS (required for FETAC accredited modules only)
Primary Secondary to Junior Certificate National Vocational Certificate Secondary to Leaving Certificate Third Level
The preferred entry level for FETAClevel 5 modules is Leaving Certificate or National Vocational Certificate Level 1, and/or relevant work and life experience. Further details of entry criteria are available on request.
Please describe any other learning, interest or background you have that is relevant to the subject; through studies, work or life experience. (Please enter description below)
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
PART 4: OTHER INFORMATION
1. Have you any special requirements/disability/allergy that we should know about? Yes No
If yes, please outline the supports you require. (Please enter your requirements below)
…………………………………………………………………………………………………………………………….
2. Have you participated in an ECO-UNESCO event in the past? Yes No
If yes, please specify which course/event. (Please enter course/event below)
……………………………………………………………………………………………………………………………
3. How did you hear about our training programmes? (Please tick the options that apply)
Email Promotion Leaflet Internet (Please state which website on dotted line below)
Newspaper Word of mouth Other (Please specify on dotted line below e.g. radio
……………………………………………………………………………………………………………………………
4. Are you a member of ECO-UNESCO? Yes No
If not, would you like to become a member? Yes, please send more information No
PART 5: PAYMENT INFORMATION
ECO-UNESCO accepts payment by cheque, postal order or bank draft payable to ECO-UNESCO or you may pay in cash by calling to our offices at 17 St. Andrew Street, Dublin 2.
FETAC: €240 €220 C&VSector €200 Members/Unwaged*/under 25s
EPV Accredited Teacher Training Week: €90
ECO Award and Peer Education Sustainability courses:
€80 €50 C&V Sector €45 Members/Unwaged*/under 25s
Shortcourses: €90 €80 C&V Sector €70 Members/Unwaged*/under 25s
€100 2 participants from same organisation (Applicable to short courses only)
FREE Event: (Please tick if you are attending a FREE ECO-UNESCO event)
*Please Note: For unwaged, evidence required e.g. medical card or receiving social welfare
PART 6: TERMS & CONDITIONS
Booking and Payment: Your place will be reserved only when a signed booking form has been received by post, email or fax. Your place will be confirmed when full payment is received. Full payment is due 5 working days prior to course commencement. We cannot guarantee your place unless payment has been received. We will accept a written cancellation of confirmed bookings up to 3 days before course commencement. However, fees will not be reimbursed if written notice is not received. Cancellation fee applies.
Data Protection and Privacy: We will not share your details with any third party with the exception of FETAC if appropriate. Your details will be maintained within our participant files and we may contact you in the future about other ECO-UNESCO services. All participants are signed up to our monthly e-bulletin newsletter. You may unsubscribe at any time.
Policy on the use of photographs and video: ECO-UNESCO may use images and/or video from our activities for publications, promotional purposes and FETAC award requirements. The signature of a parent or guardian is required for young people under 18 years of age.
Medical Assistance: By signing this form, you are authorising ECO-UNESCO to undertake appropriate first aid assistance in case of injury, accident or medical emergency.
PART 7: PARTICIPANT AGREEMENT / PART 8: PARENT/GUARDIAN AGREEMENT
(if participant in under 18 years of age)
Signature:
______Date:
______
I understand and accept all the Terms and Conditions of this contract (the above signed) / Signature:
______Date:
______
I understand and accept all the Terms and Conditions of this contract (the above signed)

ECO-UNESCO│The Greenhouse │17 St Andrew Street │Dublin 2

T: +353 1 6625491│F: +353 1 6625493 │E:

Template Version: August 2012Page 1 of 2