COMPLETE AND RETURN THIS FORM
COURSE REGISTRATION FORM
NAME OF PARTICIPANT (surname first) Please print clearly for purpose of the course certificate
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CONTACT ADDRESS ............................................................................
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TELEPHONE ................................................................................................
e-MAIL ....................................................................................................
PREFERRED COURSE LOCATION (Please tick as appropriate)
LAGOS --- (18 - 19 NOVEMBER)
PORT HARCOURT --- (25 - 26 NOVEMBER)
ABUJA --- (29 - 30 NOVEMBER)
PAYMENT DETAILS
Deposit: N
Balance: N
Full Payment: N
SIGNATURE DATE
PLEASE NOTE:
(1) Payment may be by cash or cheque made payable to:
DCON CONSULTING A/C NO. 0110 1308 1017
(CITIZENS BANK).
(2) Please bring all Bank Tellers and Receipts to the Course Venue.
(3) DO NOT send cheques or cash by regular post.