Cement and Concrete Institute

Application Form SCT 10, 11, 12, 13, 20, 21, 22, 23, 30, 31, 34, 35, 36 & 37

To register to attend a course please complete this form and it will be submitted to the Course Organiser:

E-mail sct@cnci.org.za

Fax (011) 315-0310

PO Box 168, Halfway House, 1685, Midrand, South Africa

I wish to attend the following course: Please tick the appropriate box
SCT 10	SCT 11	SCT 12	SCT 13	SCT 20
SCT 21	SCT 22	SCT 23	SCT 30	SCT 34
SCT 35	SCT 36	SCT 37
Date of course: DD: MM:

All details below are required by the CETA. It is imperative that all fields are completed. Without completion, we cannot register you. Delegates Details:
Title & Initials:		Surname:
First Name:		ID Number:
Sex:	M F	Tel no H:
Date of birth:
Tel no W:		Fax no:
Email:
Cell no:

Invoicing Details
Person responsible for payment:
(If the delegate does not take the certificate, it will be posted to this person)
Company Name:
Company Address:
Company's VAT number:
Category of Learner (Required by CETA) RACE:
African Coloured Indian White
Province of Residence:
Dietary Requirements:

Highest Qualification Achieved:
Educational Qualifications:
Grade 8 (std6) Grade 9 (std7) Grade 10 (std8) Grade 11 (std9) Grade 12 (std10) Other
Tertiary Qualification:
Trade/occupation:

Contact details of person sending you on course
Name:		Position in Company:
Tel no W:		Fax:
Cell:		Email:

Details of person to receive delegate's results if different from person responsible
Name:
Address if different from delegate's company address:

Method of payment (Please attach a copy of your company order to this form)
Cheque
Bank deposit
Cheque No:
Order No:

IMPORTANT INFORMATION
ALL FEES ARE PAYABLE IN ADVANCE.

Registration is only confirmed on receipt of full payment or an order number from customers with an account.
Customers will be invoiced on receipt of an order number or payment.
Course hours are from 08h00 to 16h15 daily.
Course dates and fees appear on pages 10-12.
Course fees include teas, lunch and comprehensive course notes.
The School reserves the right to postpone, cancel or change the venue of courses should the need arise.
Full fees will be refunded on request.
In absence of an order number or proof of payment, delegates will not be admitted on to courses.

Cancellations:

If a written cancellation is made 10 or more working days before the start of the course: No cancellation fee or transfer fee will be charged.
Less than 10 working days before the start of the course: A R750.00 cancellation fee will be charged
Transfer to a future course: A R400.00 administration fee will be charged.
On the day of the course: The full fee is payable.

Payment:

Cheques should be payable to the Cement & Concrete Institute
Electronic transfer or direct deposit into our bank account, must be validated by faxed copy of transaction slip clearly identifying the delegate(s), course and your company with every payment, proof of payment or order number to ensure that your payment is correctly allocated. Please include the account number reflected on your invoice.

Please note that registration is only confirmed on receipt of full payment or an order number from companies with an account with the C&CI. Please clearly identify the course and person(s) for which payment is being made.

Kindly attach the cheque or a copy of the bank deposit slip, made out to Cement & Concrete Institute, to the registration form. Please ensure that your payment, or proof of payment, is accompanied by a copy of this completed form.

OUR BANKING DETAILS ARE:
Standard Bank Midrand
Branch Code: 00 11 55
Account No: 201140349

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Tel: +27 11 315 0300 Fax: +27 11 315 0584 E-mail: info@cnci.org.za