NLA SHORT COURSE REGISTRATION

Fields marked as  Required must be filled in before you can submit this form. Please complete as many fields as possible to facilitate administration.
It is essential that a separate registration form is completed for each attendee

PERSONAL DETAILS
Surname Required
First Names

Required
Title
Highest Qualification
Position
COMPANY DETAILS - Please complete in full for invoicing purposes
Company/Organisation Required
Company VAT Registration Number

Order Number

Postal Address Required
Postal Code

Tel Number (Area Code) & Number  Required
Fax Number (Area Code) & Number
Mobile Phone Number

E-mail address Required
Confirm E-mail address Required
Specify any special dietary requirements

Are you an NLA Member? YES     NO Required
Select the COURSE you wish to register for

 
PAYMENT
A reference number will be sent to your email address when this form is submitted. Please use this reference number when making a payment. An invoice will be emailed to you after processing of the registration by the NLA. Payment must be received in full to confirm this registration. No refunds will apply for non-attendance; No exceptions will be made.

Contact Person for Accounts Purposes

Accounts E-mail address

Required

Required

BANK DETAILS:
NATIONAL LABORATORY ASSOCIATION
FIRST NATIONAL BANK, LYNNWOOD, PRETORIA
ACC. 54600033549 (Current Account)
Fax deposit slip to 012 349-1501
CANCELLATIONS

Cancellations received before xx will be entitled to an 80% refund. After this date, no refunds will be entertained. Registration can be transferred to an alternate delegate for a 10% substitution fee. Refunds will be processed after the

Thank you for taking the time to register!