digital workshop Registration Form

Digital Workshop

Aba Road ,Old Umuahia Abia State digitalworkshop@gmail.com

www.digitalworkshop.com.ng

09064754485
digital workshop Registration Form
- Full Name
  
  First NameMiddle NameLast Name
- Student Phone Number
  e.g. 11183021
- Year Level
  for Incoming A.Y. '12-'13
- Degree Program
- Email
- Phone Number
  Format: (000) 000-0000.
- Present Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Permanent Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Emergency Contact
  
  First NameLast Name
- Relationship
  ex. Father, Mother, etc.
- Address Of Person To Contact In Case Of Emergency
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number Of Person To Contact In Case Of Emergency
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Of Person To Contact In Case Of Emergency
  example@example.com
- High School Name
- passport photo
  
  File should be in pdf, doc/docx format.
  Cancelof
- ActingArts/CraftsCalculatingDancingDebatingDrawingEatingFashionPhotographyPlaying drumsPlaying guitarPlaying pianoProgrammingSingingWritingOthers (specify below)
- Interests
- YesNo
- Who/what is the name of your sponsor?
- YesNo
- To What Course?
- What Digital Skills Do You Want to Study
- Comments
- Please verify that you are human*
- Should be Empty: