Book On-Road Training

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IMPORTANT - All items in step 1 must be ticked before completing step 2.

STEP 1.

Please ensure you have read and understood the terms and conditions for training as laid out by your employer.

Should you require more information about these or wish to book some form of training other than in car coaching, please contact a member of our customer services team on: +44 (0)845 310 8311

I confirm I have read and agree to the terms and conditions agreed by my organisation.

I confirm I have a full valid driving licence.

I confirm I have insurance for business use.

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STEP 2.

Please complete the section below. This information will then be passed to a member of our customer services team who will arrange the session on your behalf.

Fields marked with (*) are mandatory

	Driver Information			Line Manager Information
*	First Name		*	First Name
*	Surname		*	Surname
*	Employee Number		*	Telephone Number
	Cost Centre		*	Email Address
	Purchase Order (if known)
*	Telephone Number
	Mobile Number
*	Email Address
*	Date of Birth	Please select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Please select January February March April May June July August September October November December Please select 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940

	Course Information
*	Your Company Name
	Course Duration	Half day Full day
	Special Instructions
	(Post Incident / UK Familiarisation etc)
	Please complete the section below which details on what day and time you would like your session to take place
	Morning sesssions: 9 till 12.30 (AM)  Afternoon sessions: 1 till 4.30 (PM)
*	Date Option 1		AM PM
*	Date Option 2		AM PM
*	Date Option 3		AM PM
	Training Address - Please note: This is the address where you would like the trainer to meet you.
*	Building Name / Number
	Street
	Town / City
	County
*	Postcode
	About The Vehicle
	Are you driving a hire car?	Please select No Yes
*	Type of vehicle for training	Please select Car 4x4 LCV / Van LGV - Rigid LGV - Artic Motorcycle Trailer - Car Trailer - Van Trailer - Rigid
	Vehicle Make
	Vehicle Model
	Vehicle Registration
	Comments
	Please supply any additional information you believe would be relevant for the training session: (time of day start / or important details about the training vehicle)

© IAM Drive & Survive 2010 | Customer Services  0845 310 8311