Student Enrolment Form

Student Enrolment Form

Fill out the form carefully for registration
AIMS Member Number (if applicable)
Member discounts: Associate Members 10%, Full Members 15%, CCMS Members 20%
Student Name

First NameMiddle NameLast Name
Birth Date

DayMonthYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Mobile Number
Format: 0000-000-000.
Phone Number
Format: (00) 0000-0000.
Work Number
Format: (00) 0000-0000.
Company
Desired Qualification
Please list the desired unit/s
Do you have current experience in the maritime industry (in the last 5 years)
What are your maritime qualifications?

Other (please specify below)
Other maritime qualifications
Please attach your supporting documents

Eg: CV, Qualifications
Cancelof
Is English your first language?
Are you fluent in English?
How do you intend to pay for your course?
Where did you hear about our courses?

Other
What is your objective for undergoing this course?
I declare that the information I have provided is true and correct
Date

DayMonthYear
Date
Should be Empty: