NZA Registration Qualification: L1 TC / STMS / TC R / STMS R / KCTL Course Date: Location: Personal Information Legal Names*: Date of Birth*: 5 Digit ID Number*: Mandatory for STMS or Refresher Course Home Must provide atleast 1 contact Home Address*: Home or mobile number*: Email*: Employer Information Company Name: Address: Work Contact Details: Send the ID Card to (Compulsory) Company name Company Contact Person Address Trainer Name Trainer Telephone Trainer Email Trainers to gain certification for your client provide the following: Payment: The cost is $46 GST inclusive for each certification. Trainers must wait for a NZTA invoice which will be sent once the cards are ordered. Please forward: A completed copy of this form either posted or emailed, and An electronic, head to chest photograph (see Trainers Admin Guide for example).