UCT FHS REGISTRATION FORM (Introduction to Laboratory Animal Science)

REGISTRATION FORM
Course Name: Introduction to Laboratory Animal Science
Course Date
Personal Details
Title (e.g.: Dr / Mr / Mrs / Miss)
Name*

First NamesSurname
Full Name to appear on certificate*
Student Number (if previously registered with UCT)
ID Number / Passport Number*
Date of Birth (DD/MM/YYYY)
Nationality*
Highest Educational Qualification*
HPCSA / SANC Number
Occupation
Company
Supervisor (if a degree student)
Title of Research
Animal Species Studied
Years of experience working with animals*
Years of experience working with rats and mice*
Will you personally be working hands-on with animals?*

NoYes
The following information is required for UCT reporting purposes:
Gender
Race
Disability (please select)

NoYes
If yes, please specify
How did you hear about this course?

Faculty InfomaierCEU Health EmailCEU WebsiteUCT CalenderBizcommunityFacebookTwitterWord of MouthOther
Contact Details
Postal Address
Postal Code
Country
Mobile Number
Email Address (NB: this address will be used for access to the online learning and for emailing of your certificate) *
example@example.com
Payment Information

For individuals and companies
Who is paying for you to attend this course?*

My employer/company is paying – please complete the following section “InvoicesI am paying for myself – please use the PayU details below to make payment and then proceed to the final section “Terms and Conditions
UCT PayU Portal (payment via Card)
1. Direct to the following link: https://payments.uct.ac.za/professional-development/
2. Faculty, select FHS
3. Department, select Continuing Education Unit
4. Course, select your applicable course
5. Schedule, select the applicable date and time
6. Complete your first name and surname

The course fee will be auto-populated based on the course selection.

Once you have clicked proceed, you will be directed to the terms and conditions page, where you are required to accept the terms and conditions associated with making a payment on the page.

You will then be directed to the Payment Gateway, where you will enter your card details.

NB: Please note we accept ZAR’s only and the payment gateway is enabled for Mastercard and Visa. Your issuing bank will require your authorization for the transaction for 3DS secure (you will receive a notification from your bank to enter an OTP on the site to confirm the payment).
Invoices

Issued to companies only.
NB: Tax invoices are only issued to companies. Individuals paying privately must use the banking details on the invoice received for payment. The correct reference must be used as indicated. Please do not complete this section if you are paying as an individual. Invoices will be emailed to the contact person indicated below. You should receive an invoice within 10 working days from the date of request. If payment is unlikely to reach us before the start of the course, we require a letter from your company stating their intention to pay the fee on receipt of an invoice. Once payment has been made, proof of payment must be emailed to ce.administration@uct.ac.za. For a company to receive an invoice for its employee/s attending a course, the following information must be completed:
Name of Company
Postal Address
Postal Code
Street Address
Postal Code
VAT registration number
Purchase Order Number
Business Sector (e.g. Commercial, Government, NPO)
Industry Type (e.g. Finance, Electronics, Education)
Contact person (e.g. Finance officer) to whom the invoice should be emailed
Name
Position
Email
example@example.com
Tel
Miscellaneous
Do you have any special dietary requirements? NB: Only religious requirements and allergies can be catered for.

HalaalKosherVegetarianNoneAllergies (please advise):
Allergies
If you have a food allergy, please specify here:
Do you have any other special requirements that we should be aware of?

YesNo
If you have any special requirements, please provide details:
May we add your name to our mailing list to receive notification of future courses?

YesNo
Terms & Conditions
1. We will acknowledge receipt of your registration form. If there are no available spaces, you will be notified.

2. Closing date for registrations is dependent on the particulars of each course. You may not cancel your registration after registrations have closed.

3. Fees are due four weeks before the start of the course, unless otherwise arranged with the Continuing Education Unit.

4. We must be informed of cancellations in writing at least four weeks before the start of the course or the full fee will be charged.

6. UCT reserves the right to take any legal proceedings to recover the full fees payable, and to recover the costs in connection with such recovery.

7. Certificates will be issued in the name supplied on the registration form. Certificates will be sent via email to the address on this form. No certificate will be issued until full payment of the course fee has been received.

8. Certificates will not be issued to any student who is not in financial good standing with UCT.

9. UCT reserves the right to cancel the course, in which case, the course fee will be refunded in full if already paid.

I have read and accept these terms and conditions.
Signature*

Clear
Date (DD/MM/YYYY)*
Please upload a copy of your ID *

Cancelof
Please upload a letter from your supervisor in support of your application and confirming your work with animals*

Cancelof
Should be Empty:

REGISTRATION FORM

Personal Details

Contact Details

Payment Information

UCT PayU Portal (payment via Card)

Invoices

Miscellaneous

Terms & Conditions