ENROLMENT

Full Name & Surname of Learner

ID Number of Learner

Gender Gender Male Female

Race of Learner Race of Learner White Coloured Indian Black

Name of Program for which Learner is registering

Home Language

Highest school or other qualification

Learner Special Needs Learner Special Needs Sight Hearing Mobility Learning Other

Physical Address of Learner

Postal Address of Learner (If Different)

Work Telephone Number of Learner

Home Telephone Number of Learner

Cellphone Number of Learner

Email Address of Learner

Company Name (If Paying)

Company VAT Number (If Applicable)

Physical Address of Company (If Applicable)

Order / Purchase Number (If Applicable)

Name of person responsible for paying account

Work Telephone Number of person responsible for paying account

Cellphone Number of person responsible for paying account

Email Address of person responsible of paying account

Date

I have read and accept the enrolment terms and conditions, and all information in this registration form is correct * I have read and accept the enrolment terms and conditions, and all information in this registration form is correct * (Tick to accept)

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