UCT FHS Registration Form (NVivo Only)

REGISTRATION FORM

UCT FHS Short Courses & Workshops
Course Name*
Course Date (DD/MM/YYYY)

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*
Please upload a copy of your ID*

Cancelof
Date of Birth (DD/MM/YYYY)*
Nationality
Highest Educational Qualification*
HPCSA / SANC Number
Occupation
Company
Laptop details: Are you working on Mac or Windows? (please select)*

MacWindows

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

MF
Race
Disability (please select)

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

Contact Details
Postal Address
Postal Code
Country
Cell Phone Number
Email (NB: Your certificate will be emailed to this address)
example@example.com

Miscellaneous
Do you have any special dietary requirements? Only religious reasons or allergies can be catered for Please be specific.

HalaalKosherVegetarianNone
Do you have any special dietary requirements? Only religious reasons or allergies can be catered for Please be specific.

Allergies (please advise):
Do you have any other special requirements that we should be made aware of? If yes,

YesNo
please provide details
May we add your name to our mailing list to receive notification of future courses?

YesNo

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 UCT PayU Platform details provided to make payment
Invoices

Please only complete this section if you require an invoice for a company
Please note: Tax invoices are only issued to companies. Individuals paying privately must use the banking details in Section A complete Section B if you are paying as an individual.

below for payment. The correct reference must be used as indicated. Please do not

Please ensure you complete this information as it should appear on the invoice.

Invoices will be emailed to the contact person indicated below. Please ensure you give the correct person’s details. 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

A.Electronic Transfers and Direct Deposits for Individuals and Companies:

University of Cape Town, Current Account

Riverside Centre, Main Road, Rondebosch, 7700, South Africa

Rondebosch Branch, 025009 233514 [Your Initial & Surname] e.g.: 233514PJones

233514 [Invoice Number] e.g.: 233514123456
Name of Company
Company Postal Address
Postal Code
Company 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 to whom the invoice should be emailed and is responsible for making payment
Name
Position
Email
example@example.com
Tel
UCT PayU Platform Payment

Individuals making payment are to please use this option
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).

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 two 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 one week 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 posted via registered mail 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 if insufficient registrations are received, in which case, the course fee will be refunded in full if already paid.

I have read and accept these terms and conditions.

I have read and accept these terms and conditions.
Signature*
Date (DD/MM/YYYY)*
Should be Empty:

REGISTRATION FORM

Personal Details

Contact Details

Miscellaneous

Payment Information

Invoices

Contact Person to whom the invoice should be emailed and is responsible for making payment

UCT PayU Platform Payment

Terms & Conditions