Personal
Information |
| Title: |
|
| Family
name: |
|
| Other
name(s) |
|
| Date
of birth: |
Day
|
Month
|
Year
|
| Job
title / occupation: |
|
| Organisation
name: |
|
| Postal
address: |
|
| Country: |
|
Telephone
(full STD code) |
|
Fax
(full STD code) |
|
| E-mail
address: |
|
Please
tell us a little more about yourself and the
organisation you work for, for example, your
responsibilities, the type of work you do, your
target group, what your organisation does, etc.
(We will contact successful applicants for additional information closer
to the programme start date.)
|
| |
Sponsoring
Organisation |
| Contact
person: |
|
| Postal
address: |
|
| Country: |
|
Telephone
(full STD code) |
|
Fax
(full STD code) |
|
| E-mail
address: |
|
| |
Payment
of fees
|
The programme fee is £1,700
(GB pounds sterling). For applications to be
considered they must be accompanied by payment
of fees.
Our preferred method
of payment is by electronic wire transfer.
On receipt of this application form we will
send you details of the bank account into which
payment must be transferred.
|
Administration |
Accommodation
|
Accommodation
is included in the programme package. As
accommodation space is limited, it is vital that
we receive applications as soon as possible to
ensure that we can reserve sufficient rooms for
all participants. |
Insurance
and liability
|
I
accept that in attending the Training Programme
the Springfield Centre cannot be liable for
any losses or injury that I sustain during
my visit, and I confirm that I have made arrangements
for appropriate insurances for the duration
of my visit to Kenya, particularly in respect
of personal health, accident and possessions.
I
understand that I will be personally responsible
for all charges and expenses incurred which
are not funded by a sponsoring organisation.
All charges are due at the time of registration
unless I have made alternative arrangements.
|
Date |
Day
|
Month
|
Year
|
Applicant's
Name/ Signature |
|
|
To submit your application
for the 'Making markets work for enterprise
in Africa' Training Programme
either complete this form and click 'Submit' or
print the form and fax it to + 44 191 3831616.
Closing date
for applications is
27/01/10. In order to be considered for
the Training Programme, fee payment should accompany
applications. Details of how to pay will be sent
upon receipt of this application form.
The Springfield
Centre for Business in Development Ltd
Suite One, 4 Saddler Street
Durham,
DH1 3NP
United Kingdom
T: +44 191 3831212
F: +44 191 3831616
Email: global@springfieldcentre.com |
|
