Private / Individual Booking

Participant Name: PPS Number: Date of Birth: Gender: Male Female Other Personal Address: Line 2: Line 3: Line 4: Email Address: Personal Mobile Number: Course requires 85% attendance, can you attend 85%? YES NO Place of Work: Work Address: Line 2: Line 3: Line 4: Job Title: Number of Years in Industry: Highest Level of Education: Year of Certification: Why are you interested in attending this course? How did you become aware of this course?: Website Prospectus Direct Email Advertisement Cold Call Other To complete this course will you need any accommodation? YES NO How would you like to be kept up to date on upcoming events and news? By Email By Text I don't want to be noticed How will you be paying for the course? When will you be paying for the course? Please note that failure to pay for the course before commencing will result in the cancelation of your place.

Do you feel that you have adequate information about the programmes and its associated services to enable you to successfully participate in it? YES NO

By checking the box below I certify that the information I have given is correct and accurate. I understand that HCT Ltd. may at any point in time request to inspect original documentation evidencing previous qualification or any other information provided. I further understand that furnishing HCT Ltd. with false, misleading or incomplete information relating to my booking may cause denial of my learners course