C05 Form - COAPE

C05: AFRICAN WILD DOG BEHAVIOUR

Course Enrolment Form

Student Details

First Name

Surname*

Email*

Enter Email Confirm Email

Select ID Type

RSA ID
Passport

Country of Issue*

RSA ID Number*

Passport Number*

Home Language*

Date of Birth*

Ability Status*

Description of Disability*

Occupation*

Student Contact Information

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

Person Responsible for Payment*

Who will be paying for the course?

Payee Information

First Name

Surname*

Email*

Enter Email Confirm Email

Select ID Type

RSA ID
Passport

Country of Issue*

RSA ID Number*

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 Options

Dear Course Delegate

Please read the following form carefully as it contains details about paying by installment for your selected course.

Payment terms

The full course fee totals R5,000.00
A non-refundable deposit of R1 500.00

Payment Options:
1) Pay only the deposit, with the remainder due as per the terms & conditions (R1,500.00)
2) Pay the full course fee (R5,000.00)

Deposit Payment*

Price:

Course Fee Payment Options:

The remainder of the course fee can be paid via two different options:

Option 1
Full payment of remaining course fee 1 month after start of course (R3,500)

Option 2
A monthly Electronic Fund Transfer of R428 per month payable on the last day of each calendar month (commencing the 1st month-end after registration) for 9 consecutive months following registration.
These payments will need to be made by EFT into our bank account. Please contact us for more details.
Option 2 includes a minimal 10% interest component.

Settlement Option*

How will you be settling the remainder of the course fee?

Total Payable Today

R0.00

Basic Terms & Conditions

BASIC TERMS AND CONDITIONS: (for full Terms and Conditions see website)

Right of enrolment is reserved.
Course information will only be sent out once full deposit amount has been paid.
Students must start the course within 6 months of registration. Failure to do so, without prior written consent from COAPE SA, will result in the student being deemed to have withdrawn from the course.
Should the student then wish to continue a R2 500 re-registration fee is payable.
Once a student has received the 1st set of course notes, he/she is liable for the full amount in terms of the option selected even if he/she decides to discontinue the course for any reason.
Late/non-payment of the monthly amount due could result in the following:
- Withholding of assignment marks until your account has been brought up to date.
- You not being eligible to receive your next set of course notes until your account has been brought up to date.
Course certification will only be issued to students who have settled the full amount due in terms of the option selected
You will be responsible for the postage fees for your certificate.
Courses are not transferable.

Agree to basic terms and conditions*

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

Total Payable Now

R0.00

Phone

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