Thursday - 11 - March - 2010
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Online application Form PDF  | Print |  E-mail

 

KIA Online Course Application/ Booking FormPlease fill in the form below and click on SUBMIT button, you will receive a notification regarding your qualification for the course.

 

Programme Application/ Booking Form
To register please fill in and return the form below.
Personal Details.
Family name (*)
Please type your full name.
Full Name (*)
Please type your full name.
Gender (*)
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Department (*)
Please type your full name.
Organisation (*)
Please type your full name.
Work Station (*)
Please type your Work Station
Address (*)
Please type your full name.
Postal Address (*)
Please type your Postal Address.
Telephone (*)
Please type your full name.
Fax
Please type your full name.
E-mail (*)
Invalid email address.
Next of kin To be contacted in case of an emergency.
Full Name (*)
Please type your full name.
Course Programme (*)
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Address (*)
Please type Address.
Telephone (*)
Please type Telephone number
Fax
Please type your Fax number
E-mail (*)
Invalid email address.
Education Background.
Highest level of formal education (*)
Please type your Highest level of formal education
Highest level of Professional education (*)
Please type your Highest level of Professional education
Main areas of study
Please type your Highest level of Professional education
My objectives for attending this course is are
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Sponsorship.
Sponsorship (*)
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 Tick as appropriate
The Organization wishes to register this delegate for the course indicated above. We undertake to pay his/her fee and release him/her from all organizations responsibilities for the period of the programme
.
Name of Authorizing Officer (*)
Please type your full name.
Position
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Date (*)
Please select a date when we should contact you.
How should we contact you?
  
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Fax: 254-020-4182306