registration REGISTRATION FORM

First Names


Surnames


Postal Address


Physical Address


E-mail Address


Profession / Occupation



Business Telephone


Home Telephone



Cellphone


Fax number


Level

Preferred Day
Time of Day

How did you hear about the course?
Remarks / Message

Kindly note that the course fee plus the course material must be paid in full (R1000+R150+R75=R1225) at least one week before the commencement of the course. No refund will be paid for discontinued, interrupted or partial attendance, only when a course is cancelled by the organizers due to unforeseen circumstances.

Kindly transfer total amount due electronically to:
Name of account holder: G. Jung
Account number: 51440492828
First National Bank - Cresta Branch - branch code: 254-905
Make your surname and initial the reference number
Or deposit manually and fax the deposit slip to: 792-5086
Alternatively hand deliver payment to Randpark Ridge.

I acknowledge that I have read, understood and accepted the above registration rule and I hereby register for the language course.



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