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Declaration of Modules

For delegates to confirm they know what course they are covering and that they have not completed the modules before.

By signing below you confirm you have are aware of the modules being covered on your booked course date and have not completed the same modules on a previous CPC course in this 5 year period.
Course Date*

Please enter the date of the course you are booked on. (please note, this form will need to be completed once for every day you attend)
Driving Licence Number*
Phone*
Email*
Name*
First Last
Signature*
Date*