SHORT AGRICULTURAL COURSES

Name of applicant group, organisation or individual:
Name of the contact person (person filling this form):
Designation of the contact person above (e.g. Director, Coordinator etc) where applicable:
Applicant's Address
Organisation or individual contact email address:
Organisation or individual telphone Number (mobile/landline or both):
Name of the Organisation/person paying course fee (sponsor):
Physical location of the sponsoring organisation/person (District, town and building where applicable):
Name of proposed course(s) in order of priority
First choice:
Second choice (if any):
Third choice(if any):


Any other comment or remark (briefly describe):
Number of participants expected to attend(if a group):
Today's date:
I hereby declare that the above information is correct and true and can be relyed upon in arranging for our/my participation in the course		Yes No