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Radio course registration form

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

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.


COURSE VENUE
NG Kerk, 42 Birkenhead Street, Strand
DATE
14 Desember 2019
COURSE FEE
R1650.00
SESSION 1  Lecture
SESSION 2  Lecture
SESSION 3  Revision + Examination
08h00-12h0013h00-17h0018h00

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

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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 14 Desember 2019
I want to book for the Course on 25 January 2020
Please let me know when the next course will be held?
BANKING DETAILS
Method of PaymentEFT payment
BankABSA
BranchStellenbosch
Account NameW Welgemoed
Account TypeSavings
Account Number9320426224
Please put down your Initial(s) and Surname as reference.

 
 
SECURITY CODE
Please enter the security code in the space provided below.

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