TRAINING FORM
Welcome to *Xtendom ICT, a certified computer training center in Uyo offering flexible and quality digital training — both online and offline. This form is designed to enroll students for our **online training programs*
Student's
Details:
Full Name
*
First Name
Middle Name
Last Name
Gender
*
Please Select
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Residential Address
Phone No.
*
Example: 07033122466
E-mail
*
example@example.com
File Upload
*
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Please Tick Training Days and Time (Please choose only 3 days)
*
Monday (9:00am - 12noon)
Tuesday (9:00am - 12noon)
Wednesday (9:00am - 12noon)
Thursday (9:00am - 12noon)
Friday (9:00am - 12noon)
Saturday (9:00am - 12noon)
Monday (1:00pm - 4pm)
Tuesday (1:00pm - 4pm)
Wednesday (1:00pm - 4pm)
Thursday (1:00pm - 4pm)
Friday (1:00pm - 4pm)
Saturday (1:00pm - 4pm)
Emergency Contact Name
*
Add your Emergency contact person's name
Emergency Contact Phone
*
Add your Emergency contact person's Phone No.
Emergency Contact Address
*
Add your Emergency contact person's address
Emergency Contact Email (Optional)
Add your Emergency contact person's Email
I confirm that all information provided in this form are true and correct about me
*
Confirm
I promise to comply by the rules and regulations of Xtendom ICT
*
Confirm
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field. Please add appropriate
blank
fields and text.
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