Which event are you interested in attend?

PARTICIPANT REGISTRATION DETAILS

Name

First Name

Last Name

Home Address

Email Address

Telephone Number

(###)

###

####

Cellphone Number

(###)

###

####

Age

Education and Skills

Highest Education level

Current Studies

ADDITIONAL DETAILS: YOU MUST PRE-REGISTER TO ATTEND THIS EVENT

Will you require child care facilities (age 3-12yrs only)

Yes

No

Are you a DCC Member?

Yes

No

* Course fee of R20 must be paid in order to confirm registration

Registration Deadline: Sunday 2 October 2016

Banking Details

- Account Name: DCC Hope Centre - Bank: Nedbank - Account Number: 1648021689 -

- Branch: Coastal Inland Business Unit - Branch Code: 164826 - Ref: Name + Surname PFS -

Email proof of payment to: Hopecentre@dcc-admin.co.za