Workshop Registration Form

Delegate's Information

We appreciate your interest in this Workshop. To register, please provide the following information and submit by clicking the submit button.

Title	Full Delegate Name & Surname	Designation	Email Address	Cell Number

Authorisation

NB. Forms without this Authorisation part will not be accepted.
NB. 10% Group Discounts for a group of 2 or more.

Name & Surname:
Organisation:
Vat No:
Email Address:
Preferred Seminar Date:	06 Jul 11    28 Sep 11    28 Nov 11
Telephone (XXX) XXX-XXXX:
Physical Address:
Postal Address:

Contact Details

• Fax: +27 11 807 8630
• Email: BCMregistrations@nkonki.com

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