Radio course registration form

Organised and presented by Pieter Welgemoed:
Tel. +27 83 731 1146
Mail. skipperticket@gmail.com

Individual courses
Contact me directly if you would like to arrange an individual course on a date suitable to both of us.

Complete the registration form below and email proof of payment (deposit: R650) and a copy of your identity document to skipperticket@gmail.com to confirm your booking.

COURSE VENUE	Captain's Corner (Magson Marine), 190-194 Main Road, Strand
DATE	Wednesday, 22 January
COURSE FEE	R1950.00
SESSION 1  Lecture	SESSION 2  Lecture	SESSION 3  Revision + Examination
08h00-12h00	13h00-17h00	18h00

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All fields with an asterisk (*) are compulsory and has to be completed.
 

Radio Course Registration Form NAME & SURNAME * ID NUMBER / PASSPORT NUMBER * EMAIL ADDRESS * MOBILE NUMBER * WORK TELEPHONE * ADDRESS *   (Remember town name and postal code) REGISTRATION OPTIONS * I want to book for the Course on Wednesday, 22 January I want to book for the Course on Wednesday, 5 February I want to book for the Course on Saturday, 22 February Please let me know when the next course will be held? BANKING DETAILS Method of Payment EFT payment Bank ABSA Branch 632005 Account Name MMS Radio Account Type Savings Account Number 9390029513 Reference Initial + Surname + Date of Course     SECURITY CODE Please enter the security code in the space provided below.