Course Registration Form

PERSONAL DATA
Title *
Name in Full * (Eg: Anil Kanchana Perera)
Name with Initials * (Eg: A. K. Perera)
Name to be Printed on Certificate *
Permanent Address *
(All letters will be sent to this address only)
National Identity Card No. *
IBSL Membership No.
(if any)
Date of Birth *
(dd/mm/yyyy)
Gender * Male   Female
Tel. No. *
Mobile No. *
Email *
EMPLOYER DATA
Name of Employer (Eg: ABC Private Ltd.)
Contact No.
PROGRAMME / PAYMENT DATA
Title of the Programme *
Payment Method * Full   Installments (10% Additional Fee)
Payment Amount * LKR 0.00
* Compulsory Fields