ICIRP 3rd Cohort Registration Form

ICIRP COURSE REGISTRATION FORM
Registrant Details
Full Name

First NameLast Name
Are you an employee of ICB?
Place of Employment
Job Title
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Country
Have you used an online learning platform before?
What is the highest level of education that you have completed?

Other
Attendance Type:
Please provide the names and email addresses of the persons in your group:
Payment Details
Individual Course Rate - $1,400
Group Course Rate (5+) - $1,250 pp

Payment is to be sent to:

Insurance Commission of the Bahamas

Bank of the Bahamas Limited Bank

Shirley St. Branch #03157

Account #1350002143
Please upload confirmation of transfer payment here:

Cancelof
***Employees Only*** Please select your method of payment:
Note: Employees will receive an exclusive discount.
Should be Empty:

ICIRP COURSE REGISTRATION FORM