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Helen G Events Workshops – Register

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APPLICANT NAME

GENDER

D.O.B

ADDRESS

CONTACT NUMBER

EMAIL

Identification

ID

ID EXPIRE DATE

Next of Kin

NEXT OF KIN

ADDRESS

Employment

ARE YOU CURRENTLY EMPLOYED?

IF YES, WHAT IS THE NAME OF YOUR COMPANY AND YOUR POSITION?

NAME & DATE OF THE CLASS / SEMINAR / WORKSHOP YOU ARE INTERESTED IN

EXPECTED SOURCE OF FUNDING

Yes I HAVE READ AND UNDERSTOOD THE INFORMATION (FULL NAME) NECESSARY FOR COMPLETING THIS APPLICATION FORM ACCURATELY. ANY RESULT IN THE FORM OF FALSE INFORMATION WILL LEAD TO CANCELLATION OF REGISTRATION.

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