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Radio course registration form

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

Individual courses
Contact me directly if you would like to arrange an individual course on a date suitable to both of us.

Complete the registration form below and email proof of payment (deposit: R650) and a copy of your identity document to skipperticket@gmail.com to confirm your booking.


COURSE VENUE
Captain's Corner (Magson Marine), 190-194 Main Road, Strand
DATE
Wednesday, 19 February
COURSE FEE
R1950.00
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 Wednesday, 19 February
I want to book for the Course on Saturday, 22 February
I want to book for the Course on Saturday, 8 March
Please let me know when the next course will be held?
BANKING DETAILS
Method of PaymentEFT payment
BankABSA
Branch632005
Account NameMMS Radio
Account TypeSavings
Account Number9390029513
ReferenceInitial + Surname + Date of Course

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

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