THE GERMAN / AFRICAN TECHNOLOGIES TRAINING AND PRODUCTION IN SENEGAL

REGISTRATION FORM
IMPORTANT NOTICE/ INSTRUCTIONS ON HOW TO COMPLETE THIS REGISTRATION FORM:
  1. All fields are important and must be completed with adequate Information.
  2. A confirmation of receipt will be sent to your e-mail upon receipt.
  3. To secure a placement in the centre and to have your admission processed in time, please ensure appropriate fees are paid before commencement date.

 
Surname  
Middle Name  
First Name  
Date of Birth  
Place of Birth  
Sex   male female
Religion  
Blood Group  
Genozide  
Phone Number  
Personal Address  
Official Address  
Email  
Nationality  
State / Region  
LGA / Municipal Council  
Marital Status  
Physically Challenged?   Yes No
If yes, please describe  
Full Name and Phone No. of Doctor or person
to contact in case of Emergency		  
NEXT OF KIN    
Surname  
First Name  
Nationality  
State / Region  
     
 
   
 

© WECASS TECHNOLOGY SENEGAL 2014-2015 Session