ADIA BS EN16005 Accredited by City & Guilds Refresher Signup Form The BS EN16005 Refresher course is now taken onlineCompany DetailsADIA Member Company Name* Company Representative Name (optional) First Last Representative Email Address (optional) The Login / Course information will also be sent to this person additionally to the engineer. This is useful to have a copy of the login details and information Engineers DetailsName First Last Engineers Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920This is needed for the City & Guilds databaseEngineer Mobile Number*This is important as we will send a reminder text message to the engineer about the course date and login detailsEmail Address* Enter Email Confirm Email If this email address is already in use on the system please add a number to the end of the email addresses and we will forward the engineer the login details. For example: if engineer@emailaddress.co.uk change to engineer@emailaddress.co.uk1 ADIA No* Please enter your ADIA Number shown on your current card and certificateCIty & Guilds Number* As shown on your current Card & CertificateE-Learning Signup DetailsUsername* This will be the username for the engineer to login to the Self Study Part of the course. The username needs to be unique and include the engineers name and a numberPassword* Enter Password Confirm Password Strength indicator This will be the password that the engineer will use to login to their self study part of the course. Please use a strong password by making the password a minimum of 6 characters, include special characters like $%& and capital lettersHiddenCourse LevelBS EN16005 Online Refresher Δ