322. Registration Form - 2011

Below is our Registration Form.
This can be copied filled-in and sent to us; or it can be filled upon registration at PROTS.

REGISTRATION FORM 2011.

1. Full name:……………

Postal Address:………

Phone: ……..

E-mail: ………..

Place of Work: ………….

Physical Address of Residence:……….

Date of Birth: ……

Marital Status:…...…

2. Parents/Guardian/Sponsor: Name:- …………...

Postal Address:…………………

Phone: …………..

E-mail: ………….

Place of Work:………………..….

Physical Address of Residence:…

3. Next of Kin (Name & Address) to be Notified in case of Emergency.

Name: ……………….

Postal Address: …………

Phone: ……………… E-mail:………………

Physical Address of Residence: ….

Course Applied for:

1. …………………….…

2. …………………….…

3. ………………………

I enclose the sum of (US$) or Tshs:- …………………………

For the above.

Signature: ……...........…

Date………………….…

Principal………………..

Date ………………….…