Notice of Wheelchair Workshop

WESTERN CAPE REHABILITATION CENTRE FACILITY BOARD DARE CONSULT

Wheelchair service delivery training: Professional: Intermediate: Registration form 2018

Venue: Western Cape Rehabilitation Centre

Instructions:

• Please complete electronically and email back to
• Complete one application form per participant only.
• Please refer to the information sheet for a list of tools, notes and equipment participants need to bring to the course.

Registration fees:

• R5 250.00
• R3460.00 deposit must accompany the application in order for you to be placed on the list of participants.
• The balance(R1790.00) is payable no later than 1 month prior to the date of the course.
• If you book within one month of the course, the full amount needs to be paid immediately.
• The deposit is not - refundable should you cancel within 1 month of the starting date of the course.
• Send proof of payment to: email or fax 086 5112 164
• Reprint of lost CPD certificates R200.00

Payment options:

• Cash / EFT / Cheque. See banking details below.
• Payment from Skills Development Funds: If this training is part of your development plan, and approved by both your skills development committee and your line manager, pay up front and follow your departmental procedures to claim back funds. Western Cape Department of Health participants complete the provincial Travel & Subsistence form to be reimbursed through PERSAL.
• Integrated Procurement System:Please note: Dare Consult in association with Western Cape Rehabilitation Centre Facility Board is the sole provider of this training course. The following information should be included in the tender description: Wheelchair service delivery training: Professional: Intermediate; Dates for course (see options below) and the number of participants and their names. Booking will only be secured on receipt of order number.

Banking information:

Account holder: WCRC Facility BoardBank: ABSABranch code: 512-710
Cheque account number: 406775 3915Reference: ISW_WCRC_Surname_initials

• Logis supplier number P8806 or BAS supplier number H0010743

NB: Please use an “X” to select the date that you want to attend:

Date of course:07 – 11 May 201827 – 31 August 2018

FIRST NAME(S) AND SURNAME:......

NAME AS FOR NAME TAG(first name / nickname only):......

OCCUPATION:......

PROFESSIONAL REGISTRATION NUMBER:......

POSTAL ADDRESS:......

PLACE OF WORK:......

WORK ADDRESS:......

TEL:H...... W......

FAX...... C......

E-MAIL ADDRESS: ……………………………………………………………………………………………………………….

I accept the terms and conditions as set out below: YES / NO (Tick theapplicable answer)

Terms and conditions:

• Bookings will only be secured after receipt of proof of the deposit.
• The balance is payable no later than a month before the start of the course.
• The deposit will be returned if the applicant is not accepted for the course.
• Due to the clinical nature of the training, you will need to have professional indemnity insurance.
• No refunds for cancellations within one month of the start of the course