UCT FHS Registration: Intro to Palliative Care

REGISTRATION FORM

UCT FHS short courses and workshops
Course Name*
Course Date*

Personal Details
Title (e.g.: Dr / Mr / Mrs / Miss)
Name*

First NamesSurname
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 Qualification*
HPCSA / SANC Number
If applicable
Occupation*
Company / Employer

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

Payment Information

Course fees are due in full before the start of the course.
Who is paying for you to attend this course?*

My employer/company is paying - please complete the section "Company Invoice"I am paying for myself - please using UCT PayU information below for direct payment by card
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).
Company Invoice

When a company is making payment on behalf an employee, please complete the following section.
Please note: Tax invoices are only issued to companies. When making payment, the correct reference must be used as indicated on the invoice.

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.
Name of Company
Postal Address
Postal Code
Street Address
Postal Code
VAT registration number
Purchase Order Number (if applicable)
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
Telephone

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. The Continuing Education Unit must be informed of cancellations in writing at least two weeks before the start of the course or the full fee will be charged.

5. 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.

6. Certificates will be issued according to the name supplied on the registration form if there is no previous record, or the name that currently exists on the official UCT PeopleSoft record. A copy of your current ID must be provided.

7. Certificates are issued in digital format only and will be emailed 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 or who is under disciplinary action with UCT or another academic institution.

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.
Signature*

Clear
Date*
DD/MM/YYYY
Should be Empty:

REGISTRATION FORM

Personal Details

Contact Information

The following information is required for UCT reporting purposes only.

Payment Information

Company Invoice

Terms & Conditions