APPLICATION & REGISTRATION FORM
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GENERAL INSTRUCTIONS
1. Please type or print clearly in BLOCK LETTERS. 2. Pay a NON-REFUNDABLE registration and application fee of $25 followed by $100.00 NON-REFUNDABLE seat fee. 3. Payments may be made by Credit Card at NICTD office or Commonwealth Bank Call 324- 7005 for Acct. Number. No Personal Cheque/s are accepted.
Name of Course/ Programme of Interest
*
Applicant Name
*
First
Middle
Last
Course/ NICTD? the
Gender
*
Male
Female
D.O.B
*
Citizenship
*
Place of Birth
*
Address
*
Phone Number
*
E-mail Address
*
Email
Confirm Email
Emergency Contact Name
*
Emergency Contact Relationship
*
Emergency Contact Phone Number
*
Where did you learn about the Programme/Course/Workshop/Seminar of NICTD?
Newspaper
Radio
Television
Presentations at Seminars, Civic Clubs, Organizations, etc.
Social Media
Employer
Other
Employment Sector
Public
Private
Registration Fees Acknowledgement (Non-Refundable)
*
Registration & Seat Fee –
$125.00
By completing this form, you have agreed to make the following payment in regards to holding your seat for the above listed Programme/Course.
Submit Application
