REGISTRATION FORM

27.09.10

REGISTRATION FORM: LEADERSHIP DNA

Contact person: ……….……………………………………………………..……………………………....…..
Company: …….…………………………………………………………………………………………………..
E-mail: …………………………………………………………………………………………………………….
Tel: ………………………………………………….. Fax ……………………………………………….………
Cell: ………………………………………………………………………………………………………………..
Name of workshop………………………………………………………………………………...…………….
Date of workshop: ………………………….………………………………………………………...……….…
City /venue………………………………………………………………………………………………...……

Please use separate forms for different workshops
Delegates to attend:
Name                                                                                               e-mail
1. ………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………
6. ………………………………………………………………………………………………………………
7. ………………………………………………………………………………………………………………
8. ………………………………………………………………………………………………………………
9. ………………………………………………………………………………………………………………
10. ………………………………………………………………………………………………………………
Payment:
I /We have deposited the amount of R…..……………………………….….. for ………………person/s
Into the account of:
Power Intelligence Development
First National Bank (FNB):
Branch code: 251 037 (Kolonnade, Pretoria).  Account nr: 622 5454 2634
Fax registration form and proof of payment to:(+27) 086 5665 815
Or e-mail to: workshops@powerintelligence.net. Cell: (+27) 071 4011100
or book on website: www.brendahattingh.com