CPD endorsement application "*" indicates required fields Step 1 of 4 25% Applicant detailsName of contact person* First Last Position/Job title* Company name* ABN* Phone*Email* Company address* Street Address Address Line 2 City/Suburb State / Province / Region Post code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Provider website CPD activity detailsHow many CPD activities are you seeking endorsement for?*123CPD Activity 1Name of activity 1 (as you would like it to appear on ACWA’s website)* Mode/s of delivery (face to face, online, upon request only)* Duration (if online please estimate)* If face to face, please provide the group size Please provide a description of the activity and its purpose*Please provide the link to the registration webpage for this training. If registration is arranged via email or phone instead, please share the necessary details. CPD Activity 2Name of activity 2 (as you would like it to appear on ACWA’s website)* Mode/s of delivery (face to face, online, upon request only)* Duration (if online please estimate)* If face to face, please provide the group size Please provide a description of the activity and its purpose*Please provide the link to the registration webpage for this training. If registration is arranged via email or phone instead, please share the necessary details. CPD Activity 3Name of activity 3 (as you would like it to appear on ACWA’s website)* Mode/s of delivery (face to face, online, upon request only)* Duration (if online please estimate)* If face to face, please provide the group size Please provide a description of the activity and its purpose*Please provide the link to the registration webpage for this training. If registration is arranged via email or phone instead, please share the necessary details. UploadsPlease upload: • CV with details of the qualifications and experience of facilitator/ presenters • Program outline • Optional: Marketing material such as flyers, images etc that could be used in ACWA's promotion of your CPD Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, doc, docx, pdf, Max. file size: 20 MB. PaymentThe cost is $250 per activity including GST. Total cost Price: $ 250.00 Payment method Pay now - credit card Pay later - an invoice will be sent to you Credit CardCard Details Cardholder Name
