Distance Learning Enrollment Form

Course Selection
For which course are you registering (please tick)?*
- 1-year Higher Certificate in International Trade
- 3-year Diploma in International Trade Management (Exports)
- 3-year Diploma in International Trade Management (Imports)
Year of registration*
MM slash DD slash YYYY
Which study cycle are you registering for?*
Where did you hear about the course?*
Have you previously studied with ITRISA?**

Contact During the Study Year
If we need to courier documentation to you, which street address should we use (i.e. business or private)?*
To which postal address (i.e. business or private) do you wish us to address all normal correspondence (marked assignments, progress reports, final results sheets, etc.)?*
To whom should your progress reports be sent? (Specify name, company (if applicable), postal address and e-mail address)*

Academic Record
What is the highest formal qualification that you have obtained? (copy required)*
From which institution was the qualification obtained?*
In what year was the qualification obtained?*

Payment Arrangements
Your chosen payment method (please tick)
(Remember: 2020B fee is R5 500 per subject)
Your chosen payment method (please select)*
Is your company paying for the course or are you (in your personal capacity)?*

Certification
How would you like your name to appear on your final certificate?*

If you are successful in the course and are awarded the qualification in question. (please print)
DECLARATION; I confirm that (please tick ALL squares):*
- Select All
- This enrolment form has been completed in full.
- The particulars contained in this form are correct.
- Payment or proof of payment accompanies this form.
- A copy of my South African ID or my passport accompanies this form
- A copy of my highest formal education certificate accompanies this form
- I understand that payment (or part thereof) is not refundable once I have been registered for my chosen course/subject(s).
- By signing this form, I acknowledge that I am entering into a contract with ITRISA and am therefore bound by its terms.
ID/Passport (copy required)*
Max. file size: 32 MB.
Academic Record, Highest Qualification. (copy required)*
Max. file size: 32 MB.
Signature (Print Sign)*
Date Signed*