Cement and Concrete Institute

Application Form SCT 50 Advanced Concrete Technology 2008 course

To register to attend a course please complete this form and fax or post 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
Advanced Concrete Technology
Date of cource: 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:
Physical address to which notes can be couriered:

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:
Tertiary Qualifications:
Trade/occupation:

Degrees, Diplomas, Certificates (State level or grade)
1:
Awarding body:
Subjects passed:
Date:
2:
Awarding body:
Subjects passed:
Date:
3:
Awarding body:
Subjects passed:
Date:
EXPERIENCE Please provide and attach the following information for each position held: Dates, Position, Level of responsibility, Type and nature of work. (Note: A normal CV is unlikely to provide sufficient detail)

Contact details of person resposible for 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 dates appear on pages 11
Course fees include comprehensive course notes.
Once course material has been despatched no fees can be refunded.

Payment:

Cheques should be payable to the Cement & Concrete Institute
Electronic transfer or direct deposit into our bank account, 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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