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Online Registration Form: Random House Struik Creative Writing course

Complete this registration form to secure your place on the Random House Struik Creative Writing course. Please fill in your details below, agree to the "Terms and Conditions" and then click "Register" at the bottom of the page. We will confirm your registration by email and SMS within 24 hours.

Registrations close and payment due: 17 September 2010
Course start date: 27 September 2010

Student Details

Fields in pink are required to be completed.

Surname:
First Names: As you would like them to appear on your certificate
Preferred Name: The name by which you wish to be called during the course
ID / Passport Number:
Date of Birth: DD/MM/YYYY / /
Company / Organisation:
Occupation / Job Title:
Phone: Incl. international dialling code e.g. +27
Mobile: Incl. international dialling code e.g. +27
Email Address:
Confirm Email Address:

Postal Address:

Street
City
State / Province
Postal Code
Country

If you are registered as part of a group, please indicate the names of the other students in your group. Groups of 3 or more are entitled to a 10% discount.

Group Members:

Where did you hear about this course?
Payment Options
Payment Scheme:
Payment Method:

We will contact you by telephone to obtain your credit card details.

Please pay your course fee into the Bank Account below and use your name and surname as your payment reference.

Account Name: Get Learning
Bank: Standard Bank
Branch: Claremont
Branch Code: 025109
Account Number: 04 332 0813
SWIFT Code: SBZAZAJJ

If you have been provided with a promotional code, please indicate here:

Promo code:

I require a VAT invoice
Company Name:
VAT Number:

Company Address:

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State / Province
Postal Code
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Do you have any comments, special requirements, or arrangements with GetSmarter staff?
Submit Registration
I agree to the Terms and Conditions.

Terms and Conditions:

  1. Should 3 or more students register together as a group, they will be entitled to a 10% discount provided that this has been arranged with a GetSmarter staff member.
  2. A pro forma invoice will be sent to you upon submission of this registration form.
  3. Registrations cancelled in writing before 17 September 2010 will qualify for a refund of your payment, but you will be liable for a 10% + VAT cancellation fee.
  4. Cancellations after 17 September 2010 do not qualify for a refund and registered students will be liable for the full course fee.
  5. International students will be charged the full course fee of R7,524 once off.
  6. Please note: UCT and GetSmarter reserve the right to cancel the course if there is insufficient demand. In this case students will receive a full refund of any monies paid.

Phone: +27 (0)21 685 4775 | Fax: +27 (0)21 685 4883 | Email: info@getsmarter.co.za
10 Park Rd, Rondebosch, 7700, Cape Town | PO Box 24058, Claremont, 7735, South Africa