Training Signup Form

 

Honorary First Name Middle Name Last Name

 

Degree
Other Degree
Job Title
Organization
Department
 Business Address
 Business City      State      Postal Code 
Business Country
Business Phone1      Ext.
Business Phone2
Fax
Mobile Phone
Gender Male  Female
Birthday
Home Address
 
 
Home City      State      Postal Code 
Home Country
Home Phone

Email

Primary Address
Alternate Address
Alternate Address

(Please double check the email address.  We will notify you of your acceptance via email only.)

Training Program

Please place a check mark in the boxes corresponding to the training or trainings you would like to attend.  The Technician Training is for participants from federal universities only.  The Wireless and Web Programming trainings have a fee associated with them. 

Technician Training (Federal Universities Only)
A+ Training (Amount to be announced: payable to the University of Port Harcourt)
Wireless Workshop (Amount to be announced: payable to the University of Port Harcourt)

Please enter the name and email address of your supervisor or ranking administrator

Supervisor Name
Supervisor Email Address
Alternative Supervisor Email Address

How did you hear about the training program?

 

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