Virtual Classroom Booking Form

Course registration - Online virtual classroom

COMPANY INFORMATION

Company Name(*)

Invalid Input

Company Physical Address(*)

Invalid Input

VAT Number

Invalid Input

PERSON RESPONSIBLE FOR PAYMENT

First Name(*)

Invalid Input

Surname(*)

Invalid Input

Email Address(*)

Invalid Email Address

DELEGATE INFORMATION

We are not responsible for spelling mistakes or incorrect ID or Passport numbers submitted to us.

More information on the Virtual Online Courses

Courses

Invalid Input

Starting Date(*)

Invalid Input

DELEGATE 1

Full Name and Surname of Delegate 1
(as will be printed on the certificate)(*)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address(*)

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

DELEGATE 2

Full Name and Surname of Delegate 2
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

All Delegates registered - go to Submit?

YesNo Invalid Input

DELEGATE 3

Full Name and Surname of Delegate 3
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

DELEGATE 4

Full Name and Surname of Delegate 4
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

All Delegates registered - go to Submit?

YesNo Invalid Input

DELEGATE 5

Full Name and Surname of Delegate 5
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

DELEGATE 6

Full Name and Surname of Delegate 6
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

All Delegates registered - go to Submit?

YesNo Invalid Input

DELEGATE 7

Full Name and Surname of Delegate 7
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

DELEGATE 8

Full Name and Surname of Delegate 8
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

All Delegates registered - go to Submit?

YesNo Invalid Input

DELEGATE 9

Full Name and Surname of Delegate 9
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

DELEGATE 10

Name and Surname of Delegate 10
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

All Delegates registered - go to Submit?

YesNo Invalid Input

DELEGATE 11

Name and Surname of Delegate 11
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

DELEGATE 12

Name and Surname of Delegate 12
(as will be printed on the certificate)

Invalid Input

Cell Number

Invalid Input

If registered with SACE for CPTD points, please enter you Number:

Invalid Input

Date of birth OPTIONAL
if client wants it represented on certificate - in this format yyyy-mm-dd

Invalid Input

Email address

Invalid Input

If registered with CEEPSA for CPD points please enter your Number:

Invalid Input

Remarks

Invalid Input

NON-DISCLOSURE AND INTELLECTUAL PROPERTY RIGHTS SECURITY AGREEMENT

Please read the NON-DISCLOSURE AND INTELLECTUAL PROPERTY RIGHTS SECURITY AGREEMENT carefully. Once you have read the Agreement please check below.

Accept(*)

I have read, completed and uploaded the Non-Disclosure and Intellectual Property Rights Security Agreement

Invalid Input

TERMS AND CONDITIONS

We herby confirm that I have read the relevant Terms and Conditions as laid out on the Virtual Classroom Page and in accepting this the booking, we hereby indemnify Top Compliance (Pty) Ltd, its affiliated companies, directors, shareholders, agents (whether authorised or not), employees, servants, representatives and officers ("Top Compliance (Pty) Ltd") for any claim that may arise against Top Compliance (Pty) Ltd for any loss, damage (including direct, indirect and consequential damages and/or loss of profits), costs (including legal costs on the scale as between attorney and client and any additional legal costs), expenses and/or liability (whether actual, contingent or otherwise) of whatever nature and however arising or caused (including liability in terms of section 60 and 61 of the Consumer Protection Act, 68 of 2008), which Top Compliance (Pty) Ltd or any third party may suffer, incur or sustain or which may arise, directly or indirectly as a result of the personal injury or death of our employees and/or representatives whilst they undertake training presented by Top Compliance (Pty) Ltd.

I have read and hereby agree to the above Terms and Conditions.(*)

Please Accept the Terms and Conditions

Please accept the above Terms and Conditions