REGISTRATION FORM
CERTIFICATE / DIPLOMA TRAINING
Loc : Pension House Car Park, adjacent The National Theatre,Ridge – Accra
Tel: 0244412551 / 0277774910 / Email : 1234montessori@gmail.com
Name
First Name
Last Name
GENDER
*
MALE
FEMALE
DATE OF BIRTH
*
-
Month
-
Day
Year
Date
NATIONALITY
*
RESIDENTIAL ADD
*
COURSE DETIALS
COURSE NAME: MEDICINECOUNTER ASSISTANT, LEVEL : DIPLOMA
EDUCATIONAL BACKGROUND
*
CUREENT JOB / WORK PLACE
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
DECLARATION
I pledge to abide by the rules and regulations as bestated by M.C.A.S during my training
*
Agreed
Submit
Should be Empty: