HUMAN SYNERGISTICS LSI ACCREDITATION FORM

Readiness Statement

Participants enter the Workshop aware that the group work training involves the development of new views and new actions with respect to their own professional and personal life and that this is likely to have a significant emotional impact. In the course of the explorations and expression, participants are always in charge of and responsible for the level of their interactions and self-disclosure. We advise participants who are undergoing significant personal stress to postpone attendance. Learning experiences can be intensive and unsettling emotional experiences. The act of enrolling in itself indicates an applicants understanding and acceptance that such explorations are part of the Workshop.

Personal Details

This information will be used to create your personal profile.

Full Name

Primary Email*

*Please confirm that your email address is entered correctly.

Position

Secondary Email*

*Used to reset portal access if you lose login details or change jobs.

Phone

Mobile

Address

Materials for the program will be shipped to this address. If you are working from home please provide your home address.

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Registration Requirements

Requirements to register for the LSI Accreditation Program.

We recommend that LSI Accredited Practitioners have coaching experience, facilitation skills, and/or relevant professional qualifications before registering.

I have experience in coaching, facilitating and/or relevant professional qualifications.

Please read through the Human Synergistics terms and conditions. Terms and Conditions - Online

I have read and accept the Human Synergistics Terms and Conditions.

Acceptance of the Human Synergistics Terms & Conditions is required prior to attending the accreditation program. If you do not accept, please continue completing your application form and a member of our team will be in contact.

Please read through the Human Synergistics Accreditation Deed. Accreditation Deed - Online

I have read and accept the Human Synergistics Accreditation Deed.

Acceptance of the Human Synergistics Accreditation Deed is required prior to attending the accreditation program. If you do not accept, please continue completing your application form and a member of our team will be in contact.

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Account Details

My company has an existing account with Human Synergistics.

Account Set-up. Provide details to create an account for your company.

Company Name

Trading Name

Industry

ABN

Physical Address

Postal Address

Key Contacts. List the main contact for the account and a contact for accounts payable.

Main Contact

Phone

Suburb / State

Accounts Contact

Phone

Suburb / State

Invoicing and Insurance. Invoicing requirements and professional indemnity insurance.

Invoices require a purchase order number.

If yes, please detail the format and any specific requirements below.

Statement Email

Generic Accounts Email

Professional Indemnity Insurer Name

Cover Amount

Expiry Date

AHRI Members may have access to PI Insurance cover as a result of their membership. Please see https://www.ahri.com.au/member-services/benefits/ahri-procover/ for more information.

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Select Program

Public programs are any programs that are available on our website.

Private inhouse programs are private groups that have been pre-arranged through your Account Manager.

Select the type of program.

Public Program
Private Inhouse Program

Select the Delivery mode.

Virtual
Virtual

Virtual Program Selection (3 x half days, 2 x full days)

Face-to-Face Program Selection (2 x full days, 2 x full days)

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Your LSI Client Details

Nominate the first person you will debrief using the LSI.

This person will be the first you debrief using the LSI. They will complete their own LSI 1&2 and their data is essential for you to be able to attend the Technical Workshop.

First Name

Last Name

Company Name

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