Learner’s Details

First Name (Please enter name as you would like it on your NEBOSH certificate)*

Last Name (Please enter name as you would like it on your NEBOSH certificate)*

Phone Number*

Email (your username and password for online exam will be sent to the email address you
provided)*

D.O.B (required by NEBOSH)*

Gender*
Please selectMaleFemale

Nationality*

Are you sitting your exam inside or outside the UK?*
—Please choose an option—Inside the UKOutside the UK

Postal Address (Please enter the address you want your certificate sent)*

City/Town (Please enter the city/town you want your certificate sent)*

Postcode*

Previous NEBOSH Learner Number

Your Learning

Which course would you like to study?*
Please selectNEBOSH National General CertificateNEBOSH International General CertificateNEBOSH HSE Process Safety ManagementNEBOSH National Diploma

Which learning method do you prefer?
Please selectOnlineLive OnlineDistance LearningClassroomBlended Learning

Do you require access arrangement or reasonable adjustment?

Payment details

Will you be funding the course personally or via a business?*
Please selectPersonal FundingBusiness Funding

Self Funding payment options
Please selectBACS/Bank TransfersDebit/Credit CardPayPal

If your company is providing a purchase order please insert it below as well as the company’s address:

How did you hear about us?*
Please selectNEBOSH websiteGoogle searchGoogle AdsWord of mouthLinkedInTwitterFacebookOnline directoryOther search engineOther

I accept Horizon Risk Consultancy Ltd' Training Course T&C's below*