Registration form

<BODY BGCOLOR="#FFFFFF" TEXT="#080000" LINK="#0000BF" ALINK="#80028F" VLINK="#660099"> <div> <I>  </I></div> <DIV ALIGN="LEFT"></DIV> <div> <B>U kan hierdie vorm uitdruk en na die </B><B>Sentrum</B><B> faks of pos</B></div> <div> <B>You can print this form and fax or post it to the</B><B> Centre</B></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="FARMING SUCCESS"><U><B>Home</B></U></A>  | <A HREF="courses.htm" TARGET="_top" TITLE="ShortCourses"><U><B>Back to short courses</B></U></A></div> <bR> <bR> <div> <B>REGISTRASIEVORM / REGISTRATION FORM</B></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="566" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> Titel/Title:   </div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 16 WIDTH="556"><div> Van/Surname:</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 16 WIDTH="556"><div> Voorletters/Initials:</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> Beroep/Occupation:  </div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 71 WIDTH="556"><div> Posadres/Postal address:</div> <bR> <bR> <div> Poskode/Postal code:</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> Tel. no. (W):               </div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> Tel. no. (H):</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> Fax:</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> Cell:   </div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> E-pos/E-mail: </div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> Handtekening/Signature:</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 37 WIDTH="556"><div> Naam van kursus/Name of course:</div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="556"><div> Date of course:   ____/____/200___</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 71 WIDTH="556"><div> <B>Belangrik/Important:</B></div> <div> Dui asb. die taal aan waarin u die kursusmateriaal verlang:</div> <div> Please indicate the language preferred for the course material:     </div> <div> Afrikaans ____  English ____</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 34 ><NOBR><div> Betaling van 20% van die kursusgeld hierby ingesluit.</div> <div> Payment of 20% of the course fees included herewith.          R______________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 98 WIDTH="556"><div> <B>Bankbesonderhede/ Bank details:</B></div> <div> Landboubestuur, UV</div> <div> ABSA Brandwag</div> <div> Account no. 913 084 8371</div> <div> Branch code:  630 734</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 47 ><NOBR><div> <B>Skryf slegs u naam in die verwysingsgedeelte op die depositostrokie in.</B></div> <div> <B>Please just put your name as reference on the deposit slip.</B></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 221 ><NOBR><div> <B>Stuur asb. terug aan/Return with deposit to:   </B></div> <div> Sentrum vir Landboubestuur (Int. posbus 66)</div> <div> Fakulteit Natuur- en Landbouwetenskappe</div> <div> Universiteit van die Vrystaat</div> <div> Posbus 339</div> <div> Bloemfontein 9300</div> <bR> <div> Centre for Agricultural Management (Int. box 66)</div> <div> Faculty of Natural and Agricultural Sciences</div> <div> University of the Free State</div> <div> P.O. Box 339</div> <div> Bloemfontein 9300</div> <bR> <div> <B>Faks asseblief registrasie en inbetaalstrokie na:   (051) 401-3473 of 2557 (Aandag: Sentrum)</B></div> <div> <B>Please fax registration and deposit slip to:  (051) 401-3473 or 2557 (For attention: Centre)</B></div> </NOBR></tD> </tR> </TABLE></div> <bR> <div> <B> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="193" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 25 ><NOBR><div> <A HREF="mailto: duPlesDM@sci.uovs.ac.za" TARGET="_top" TITLE="mailto: duPlesDM@sci.uovs.ac.za"><U><B>duPlesDM.sci@mail.uovs.ac.za</B></U></A></div> </NOBR></tD> </tR> </TABLE></B></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="FARMING SUCCESS"><U><B>Home</B></U></A><B> | </B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><A HREF="courses.htm" TARGET="_top" TITLE="ShortCourses"><U><B>Back to short courses</B></U></A></div> </BODY>