Please Complete All Fields In CAPITAL Letters:

EDUCATION STAFF DEVELOPMENT DEPARTMENT S1A Level 3 Tel. No. : (+966) 01- 5620000 Ext. 4024/4029 Fax # . : (+966) 01- 5624652 Email: [email protected]

Course Registration Form. PARTICIPANT DETAILS – Please complete all fields in CAPITAL letters:

First Name: Family Name:

Title (Dr, Mr, Mrs, Ms): Position :

Organization/Company: Email:

Mailing Address: City:

Postal code: Country:

Telephone: Fax:

Mobile Phone:

COURSE: Please specify below your Course Date/Time Tuition payable amount

TOTAL PAYABLE REGISTRATION FEE AMOUNT SR

Important Notes: (1) Registration deadline is ten days before program date. (2) Course registration confirmed only upon: a. Receipt of full payment. Please email or fax your bank slip ASAP.

Cancellation Policy: (1) All cancellations to be received in writing, via email or fax. (2) Any cancelled registration will be subject of a processing fee of 25%. (3) No refunds for cancellations received after registration deadline. Note: All refunds will be processed after the course dates.

Payment method: Account Name: Sultan Bin Abdulaziz Humanitarian City Bank Name: Saudi British Bank Account No. : sa7945000000018-063388-006 Bank Branch: Takhasusi Branch

I accept the conditions stated in this form

Date ____/____/____ Participant’s Signature : ______