COURSE REGISTRATION FORM

Please complete the following information to register for the selected course/s. All Fields marked * with have to be completed in order for the form to be submitted

Select a Course *

Preferred commencement date: *
First Name: *
Title: *
ID Number/Alternate eg: Passport: *
Gender: *
Home Language: *
Any Learning Difficulties you wish us to know about? :
E-mail : *
Other Contact Number :
Postal Address :

Date: *
Last Name: *
Date of Birth dd/mm/yyyy: *
Ethnic Background (For statistical purposes only, required by ETQA): *
Nationality: *
Disability Status:
Business/Day Time Telephone Number : *
Mobile Number: *
Physical Address : *
Company Name :

An alternate contact is a person we can contact in case of an emergency while you are attending a CPMD course.

Alternate contact person: *

Alternate contact tel: *

Bank Account Details:

Bank:
Branch:
Branch no:
Account no:
Account Holder:
Your reference:

Nedbank

Campus Square

158105

1581 085 834

CPMD

Please use your name as reference of payment

Selection payment option: *

Cheque (by post)
Direct deposit / Electronic
Cash (Hand delivery)
Special Arrangement Request

PLEASE NOTE: Proof of payment to be emailed to: info@cpmd.co.za or faxed to 011 728-7228 Payment must be made 48 hours prior to the course commencing. Module payment terms available on request Completion of this enrolment form constitutes acceptance of the terms and conditions of enrolment I declare that the information furnished above is truthful and accurate

TERMS & CONDITIONS

1.	Individual students are required to fill in a registration form online or by fax, to reserve a place on *ANY* of *CPMD’s* courses. This rule also applies to companies sending more than one student on any course, even if a bulk payment has or will be made.
2.	Tax invoices will be issued by *CPMD* on request.
3.	Under no circumstances will students be able to attend ANY of *CPMD’s* public courses unless payment is received prior to module / course commencement, i.e. by close of business the previous day.
4.	*CPMD*is registered for VAT, therefore all prices quoted are inclusive of VAT unless otherwise stated.
5.	In order to verify payment, a copy of the direct deposit slip or electronic payment slip must be faxed through to *CPMD* prior to course commencement.
6.	Only by special arrangement with *CPMD,*will students will be allowed to pay by cheque or cash during registration on the first day the course commences.
7.	A student’s place will only be confirmed for the course registered, on receipt of payment.
8.	A refund of 75% of course fees paid by the student will be given if attendance at the course is cancelled at least 15 working days prior to the course commencing.
8.1	A refund of 50% of course fees paid by the student will be given if attendance at the course is cancelled at least 5 working days prior to the course commencing.
8.2	A student is responsible for the full course fee once the course has commenced.
9.	*CPMD* reserves the right to cancel any programme. Should this become necessary to do so, then students will be given a full refund.
10.	Attendance on any programme may be postponed (excluding AAT) if *CPMD* is notified at least 72 hours prior to the relevant course commencing.
11.	Requests for refunds and postponements of courses that do not fall within *CPMD’spolicy outlined in Clauses 8, 8.1, 8.2, 9, 10 above will be at the sole discretion of CPMD’s* management.
12.	Most of *CPMD’spublic courses are conducted at CPMD’s* head office. However, course venues may be subject to change.
13.	While CPMDwill endeavour to ensure the safety of students property and their health and well-being while attending any one of its courses, CPMD will not be held liable for any loss or damage to personal belongings and the health and safety of students caused by any reason whatsoever, including but not limited to, the negligence or omission of any of *CPMD’s*owners, management, employees or its agents.
14.	Beverages and lunch are provided where indicated.
15.	Students may enquire about bulk booking discounts. Bulk booking discounts will usually be given to organizations that send 4 or more learners on any one particular course.
16.	*CPMD* will not provide any training material to a learner prior to the course commencing. Relevant material is provided on the day the course / module commences. Material cannot be bought independent of the course / module concerned, attendance is required in order to receive training material.
17.	These terms and conditions are subject to change without prior notice.