Fillable Registration Form 2019 Fillable

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Registration Form 2019 Fillable

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* DENOTES FIELD MUST BE COMPLETED Page 1 of 2
REGISTRATION FORM
New Students: Please complete ALL sections.
Returning Students: Please complete ONLY sections A, C, D, E, F and H. If however, there are changes to contact information
(section B) or emergency contact information (section G), please complete these sections also.
SECTION A: PERSONAL INFORMATION
STUDENT ID #:
NATIONAL REGISTRATION #:
NAME:*
(Mr./Mrs./Ms./Miss./Other)
(First Name) (Middle Initial) (Surname)
OTHER NAME(S):
(If Applicable)
(Maiden Name or Former Surname)
SECTION B: CONTACT INFORMATION
HOME ADDRESS: *
EMAIL ADDRESS: *
TELEPHONE NOS.:*
(H)
(W)
(C)
DATE OF BIRTH:
/ /
yyyy mm dd
GENDER:
MALE
FEMALE
COUNTRY OF BIRTH:
NATIONALITY:
SECTION C: EMPLOYER INFORMATION
NAME OF COMPANY/
ORGANIZATION: *
ADDRESS:
PRESENT JOB TITLE:
SECTION D: COURSE/SEMINAR INFORMATION
TERM:*
Please tick () the appropriate box ( )
YEAR:*
1
2
3
Summer
CODE/TITLE:*
(Course/Seminar Code)
(Course/Seminar Title)
DAYS:
TIME:
PAYMENT: (OFFICIAL USE ONLY)
FEE PAID: $
MEMBER-FEE:
CASH:
CHEQUE:
#:
DATE: Y M D
N0N-MEMBER:
DR CARD
CR CARD
#:
OFFICIAL RECEIPT #:
CASHIER’S SIGNATURE:
* DENOTES FIELD MUST BE COMPLETED Page 2 of 2
SECTION E: SPONSOR INFORMATION
Please tick () the appropriate box ( )
SELF-SPONSORED
COMPANY SPONSORED
NAME AND TITLE OF COMPANY CONTACT PERSON (if sponsored):
Name :
Title:
SECTION G: EMERGENCY CONTACT INFORMATION
NAME:
RELATIONSHIP:
CONTACT NOS:
(H)
(W)
(C)
SECTION H: HOW DID YOU HEAR ABOUT US?
Please tick () all that apply
TV Ad
Radio Ad
Newspaper Ad
Word of Mouth
Website
Social Media Site (Twitter, Facebook etc.)
Currently Enrolled in a BIMAP Programme
Recommended by Employer
BIMAP Sponsored Event (e.g. Crop Over
event, Calypso Tents)
Recommended by a BIMAP Staff Member
Name of Staff Member:
_____________________________________________
Other (please specify)
________________________________________________
Signature: ………………………………………………………………………………………………………………
Date: yyyy / mm / dd
SECTION F: PROGRAMME INFORMATION
Please tick () the appropriate box ( )
PROGRAMME OF STUDY:
1-YEAR BCMS
2 ½-YEAR BDMS
BBA
AREA OF SPECIALIZATION:
Accounting/Finance
Administrative Management
Event Planning & Conference
Management
Financial Management
General Management
Human Resource
Management
Management of Information
Technology
Marketing Management
Production and Operations
Management
Supervisory Management
Tourism Management
IS THIS COURSE/SEMINAR YOU ARE PURSUING RELATED TO THE ABOVE COURSE OF STUDY?
YES
NO
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Registration Form 2019 Fillable

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Completed 6 October 2021

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