Training Registration Form

HEALS Registration Form
Course Name
Have you included the course study material courier fee to your course fee payment total?
NOTE: Study material courier fees of R170 should be paid together with the course fees for all registrants living/working outside Bloemfontein.
To continue with this registration please make sure to include the courier fees as part of the course payment total to allow us to courier the study material to you.

Personal Details

Preferred study material delivery address:
Meal preferences:

Terms and Conditions

- No refunds if cancelling within 14 days prior to the course.

- 50% refund if you cancel 15-30 days prior to the course

- 75% refund will be made if you cancel a full calendar month or more prior to the course.

- Any requests to postpone a confirmed (and paid) course booking will be charged a postponement fee equal to 30% of the course fee.

Payment Details

Bank name:               ABSA
Account name:          Health Embassy Group Practice
Account number:     4093 1603 74
Branch type:              Cheque account
Branch code:             632005
Branch name:           Brandwag
Reference detail:     (Your initials and surname)

Completing your application

I confirm that in signing this application I have read and understood the terms and conditions above and I also agree to them. I understand that once I have made a registration payment, I have committed to attend the course.

I understand that the course dates on the course schedule may be changed or cancelled if there is less than a minimum number of students needed to present a course.

Maximum upload size: 5MB
Maximum upload size: 5MB