A member of
Certified Business Leadership Development Program _____________________________________________________________________________________ Personal details:
Name (s): Surname: ID /Passport number: Date of birth: Gender: Cell: Email address: Permanent Address: Top most Qualification held University College Institute: (please indicate below whether you have masters, degree): PhD/Degree/Diploma name Year of started: Year of completion: _________________________________________________________________________________________ Company details: Company name: Position Held in Organization: Company Address: Phone Number: _____________________________________________________________________________________
Sponsor (please tick) PersonalCompany
Payment terms (please tick) Full paymentQuarterlyMonthlyOther
Fees Structure: Program fee – RTGS$24 000.00 (Subject to change, please call for prevailing rate before payment)
Ecocash Merchant Code: *151*2*2*15535#
One Money Account: 263 719 795 764
Bank :Stanbic Account Name :Marketers Association of Zimbabwe Account No :9140000158460 Branch :Samora Machel Avenue
Terms and Conditions: ▪ No refund ▪ Fees are not refundable should a student drop out of the program midway. ▪ Venues are subject to change on notice as necessitated by demand considerations. ▪ This registration forms constitutes a contract between the two parties, once signed it is binding on both parties. ▪ Submit proof of payments on all online payments, to Accounts department for verification and capturing. ▪ Once registered you are obliged to pay the full amount, whether you attend lectures or not and whether you complete the program or not. ▪ Full fees must be paid before the examination date. ▪ All approved installments must be paid by the 1st of every month in advance. _____________________________________________________________________________________
Attach the following documents Copy Identity document, ID or Passport and your CV.
Declaration The information supplied is true and I do hereby agree to abide by the terms and conditions of the Marketers Association of Zimbabwe as set out in the registration terms and conditions. Date: Applicant’s signature
Please Note: FOR ALL ONLINE REGISTRATIONS EMAIL THE APPLICATION FORM TO email@example.com also include your payment reference number.
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