UCT FHS Registration (Essential Steps in Managing Obstetric Emergencies)

REGISTRATION FORM

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

Personal Details
Title (e.g.: Dr / Mr / Mrs / Miss)
First Names*
Surname*
Student Number (if previously registered with UCT)
Date of Birth*
ID Number / Passport Number*
Please upload a copy of your ID*

Cancelof
Nationality*
Highest Qualification
HPCSA / SANC Number
If applicable
Occupation
Company / Employer
Address:
Postal Code
Country
Cell Phone Number
Email (NB: Your certificate of completion will be emailed to this address)
example@example.com

Other Information
Do you have any special dietary requirements? (NB: Only religious or allergies can be catered for)

NoneHalaalKosherVegetarianAllergies
For allergies, please provide more information here
May we add your name to our mailing list to receive notification of future courses?*

YesNo

Payment Information
Who is paying for you to attend this course?*

My employer/company is paying - please complete the following 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

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 (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. Course fees are due immediately upon registration, 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 official UCT PeopleSoft record or in the name supplied on the registration form if there is no previous record.

7. Certificates 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.

9. UCT reserves the right to cancel the course at their discretion.

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

Clear
Date*
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REGISTRATION FORM

Personal Details

Additional Information

Other Information

Payment Information

Company Invoice

Terms & Conditions