Tranquilliser Licensing & AIIMS Training Form

Which component of training would you like to apply for?

I'm applying for a tranquilliser licence only (Vets only)

I'm applying for AIIMS training only

I'm applying for both tranquilliser licence and AIIMS training (Vets only)

Name(Required)

First Last

Email(Required)

Phone(Required)

Role(Required)

Veterinarian

Vet Nurse

Clinic or Organisation name(Required)

Clinic or Organisation Address(Required)

WA Candidates are not eligible for tranquilliser licensing at this time.

Street Address Address Line 2 City State Post Code

Preferred postal address if different to above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Clinic opening hours

Number of vets employed at clinic or organisation(Required)

Average number of wildlife cases treated per week(Required)

Is your clinic equipped to treat common wildlife species? Please also include any specific examples that your clinic may be equipped to provide treatment/care for(Required)

Any existing relationship with wildlife carers groups/organisations? If yes, please list the groups/organisations names here(Required)

Current firearms licence category and number (if held)

Reason for wanting to undertake the AIIMS training?(Required)

Taronga wildlife training for veterinary professionals course(Required)

https://www.taronga.org.au/education/veterinary-professional-training

Already completed

Currently undertaking

Would like to undertake

Not interested

Would you like to be contacted about sponsored places in the next VBB Taronga cohort?(Required)

Signature