GIS Course Application

Title *

Last Name *

First Name *

Date of Birth *

Month

Day

Year

Home Address *

Telephone *

Mobile *

E-Mail *

Education

Secondary/High School

Final Year Completed

Month

Day

Year

Qualification Obtained

College

Final Year Completed

Month

Day

Year

Qualification Obtained

University

Final Year Completed

Month

Day

Year

Qualification Obtained

University Post Graduate

Final Year Completed

Month

Day

Year

Qualification Obtained

Other

Other Education

Final Year Completed

Month

Day

Year

Qualification Obtained

Specific Research Interests *

Training Type *

Introductory

Project Specific

Software_Specific

Details

If you ticked Project- or Software- Specific for above, give details

Company/Department

(Students, give information about the academic department to which you belong)

Position

Name of Organisation *

Department *

Address *

Telephone

Fax

Duties *

Reason *

What is your reason for attending the course?

Other Reason

If reason above was other, please describe

Previous Participation *

Yes

Have you ever participated in a GIS course before?

Details

If the answer to the question above was yes, please give Details

Best Days *

Mon & Wed

Tues & Thurs

Please indicate the training days that best suit you (Introductory Course only)