Learner Registration Form

First Name
Surname
Address 1
Address 2
Town
County
Email Address
Mobile No.
Landline No.
PPS No.
Date of Birth
Gender
Course Code & Title
Choose Course
Are you working towards a QQI Major Award?
Course Fee
Do you have any requirements we should be aware of?
Company Name (to invoice)
Company Contact Name
Company Email 
Company Address (in full)
Deposit to pay
Do you have a Medical Card No?
Medical Card No.
Are you in receipt of a Dept. of Social Welfare Payment/Grant?
I would like to receive information on Lir Training Courses by email

Lir|Business Services & Training Centre Ltd

42 Mount Street

Mullingar

Co. Westmeath.

 

Tel: 044-93 42754

Fax: 044-93 42755

training@lirbusinesscentre.com

 

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