Activity Title: Introduction to Emergency Risk Management -
Activity Number: 2009.98
OFFICE USE ONLY
A flexible delivery approach provides greater access to emergency management
training for Western Australians.
It is important for nominees to complete all parts of the nomination form to assist with
communication for nominations, assessment and information exchange.
Given Names: Email:
Surname Date of Birth: / /
Mr Mrs Ms Miss Other:
Organisation Position Held
Business Phone: Mobile Phone:
Home Phone: Fax Number:
Applicant’s Signature Date: / /
Before submitting this form to the appropriate office, please check that you have:
Completed all of the required sections of this form, especially your current email and fax
Fax this form to FESA on fax number: 08 9323 9462.
FESA, FESA HOUSE, 480 HAY STREET, PERTH PHONE: 08 9323 9336 FAX: 08 9323 946