Online Registration Form

Kindly fill in this form, print out and fax to 011 672 9052 Training - Online Registration     Company Name Postal Address Postal Code VAT Reg. No. Telephone Number Fax Number Delegate Name (For certificate) ID Number (For certificate) Delegate Cell Number Email Course Title Course Date Diet/Medical Please indicate any special dietary/medical conditions Contact Person Contact person/telephone number in the event of an emergency Subject Knowledge Please tick the level of subject knowledge (1 = low to 5 = high) 1   2   3   4   5 Details Details go here...     PAYMENT DETAILS Full payment is required within 7 days of invoice: Company Order No. Contact Person SAQI Member Yes  No      SASQ Member Yes  No    Today's Date Payment Method EFT  Cheque  Direct Deposit   Cheques can be made out to Or direct deposit to: Statistical Quality Management Institute Bank Name: Standard Bank of South Africa Account number: 001234471 Branch code: 02306 Please fax copy of deposit slip or proof of EFT to 011 672 9052   *SQMI reserves the right to postpone and reschedule courses for an alternate date *Cancellation should be done 15 days prior to the course commencement date and is subject to a       10% administration fee due to cancellation *Cancellation made 10 days prior to the course is subject to a 50% cancellation fee *Cancellation on course commencement date is subject to full payment. *All registrations must be received at least 10 days before courses commencement Customer signature:  ...............................................   Date:............................................