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: R450) and a copy of your identity document to skipperticket@gmail.com to confirm your booking.

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, 6 December I want to book for the Course on Wednesday, 13 December I want to book for the Course on Wednesday, 24 January Please let me know when the next course will be held? BANKING DETAILS Method of Payment EFT payment Bank ABSA Branch Stellenbosch Account Name W Welgemoed Account Type Savings Account Number 9320426224 Please put down your Initial(s) and Surname as reference.     SECURITY CODE Please enter the security code in the space provided below.