AB04: YOU AND YOUR RESCUE DOG

Course Enrolment Form

Student Details

First Name*

Surname*

Email*

Enter Email Confirm Email

RSA ID Number*

Occupation*

Home Language*

Date of Birth*

Special Circumstances*

Are there any physical/learning disabilities we should be aware of?

Details of Disability*

Student Contact Information

Cell Number*

Alternate Contact Number

Physical Address*

Street Address City/Suburb Province/State Postal Code Country

Postal Address

Same as physical address

Postal Address*

Street Address Suburb City Province/State Postal Code Country

Person Responsible for Payment*

Who will be paying for the course?

Payee Information

First Name*

Surname*

Email*

Enter Email Confirm Email

Select your ID Type

RSA ID
Passport

RSA ID Number*

Country of Issue*

Passport Number*

Cell Number*

Alternate Contact Number

Physical Address*

Street Address Suburb City Province/State Postal Code Country

Postal Address

Same as physical address

Postal Address*

Street Address Suburb City Province/State Postal Code Country

Payment Terms & Conditions

Dear Course Delegate

Please read the following form carefully.

Payment terms
The full cost of the course is R2 500 and is payable in full on registration.

Basic Terms & Conditions

Right of enrolment is reserved.
Once a student has received the 1st set of course notes, no refund of a portion of the course fee will be considered, even if he/she decides to discontinue the course.
You will be responsible for the postage fees for your certificate.

Full terms & conditions can be accessed on our website
Courses are not transferable.

Agree to terms*

Yes

I hereby agree to the abovementioned payment terms and undertake to fully settle the amount specified by the given date.

Referral Information

To assist in our marketing please can you tell us where you heard about us from?

How did you hear about us?

COAPE SA Rep*

Anthea Fuller
Danielle Pitt
Lerica le Roux
Renate De Villiers
Tayla Tucker
Toni Muller

Other (Please specify)

Magazines

Animal Talk
Dog Directory
SA Pet Pages

Personal Referral from?

Payment & Confirmation

Course Price

Price:

Total Payable Now

R0.00

Phone

This field is for validation purposes and should be left unchanged.

[email protected]

AB04 Form

AB04: YOU AND YOUR RESCUE DOG

Course Enrolment Form

Student Details

Student Contact Information

Payee Information

Payment Terms & Conditions

Dear Course Delegate

Basic Terms & Conditions

Referral Information

Payment & Confirmation