Application Form

COURSE FEES VALID 01 MAY 2011 - 30 April 2012

PLEASE COMPLETE ONE FORM PER APPLICANT!

*Course Venue:

*Course Date:

*Referred by:

PLEASE ENTER ACCURATELY!

_______________________________________________________________

*Name:

*Surname:

*Initials:

*Email:

*Cell:

*Telephone:

*Postal Address:

*Physical Address:

*Nearest Town:

_______________________________________________________________

*Employer (Name and Surname):

Email:

Cell:

Telephone:

Postal Address:

Physical Address:

Nearest Town:

________________________________________________________

Training required:

South Africa Namibia VAT incl.

___________________________

ZAR 1,850.00

N$ 2,127.50

ZAR 950.00

N$ 1,092.50

ZAR 1,150.00

N$ 1,322.50

ZAR 2,000.00

N$ 2,300.00

ZAR 2,000.00

N$ 2,300.00

ZAR 5,000.00

on Quote

ZAR 1,750.00

on Quote

__________________________________________________________

Breed of Cattle:

Type:

Doing AI at present:

Any breeding problems:

(please describe)

Other remarks:

_______________________________________________________________

* required fields!

LTS general Terms and Condiditons apply

For deposits from countries other than South Africa or Namibia, a fee of

R 150.00 applies to cover bank charges.

TO SECURE YOUR BOOKING PLEASE PAY THE FULL COURSE FEES IN ADVANCE INTO THE FOLLOWING BANK ACCOUNT AND EMAIL US PROOF OF PAYMENT

(Please use initials and surname of trainee as reference)

BANKING DETAILS FOR PAYMENTS:

If you are attending courses in SOUTH AFRICA:

Account name: Rothman Livestock Training Services

Bank: Standard Bank

Branch name: Braamfontein

Branch Code: 00 48 05

Account number: 202 66 81 69

Account type: Cheque / Current

If you are attending courses in NAMIBIA:

Account name: Luxury Investments Ten (Pty) Ltd

Bank: First National Bank

Branch name: Maerua Mall

Branch Code: 282-273

Account number: 6224 1528 308