Please enable JavaScript in your browser to complete this form.NAME OF COURSEName *FirstLastCheckboxesMrMrsMsDrProfGenderMaleFemaleProfessionInstitute/OrganizationPositionSponsorship statusIndividualOrganizationContact detailsTelephone/mobileEmail *Special dietary requirementsYesNoIf yes, please specifyInvoicing detail. Name of person and/ or Organisation to whom the invoiceshould be adressed Did you apply for scholarshipYesNoMotivational letter submittedYesNoCourse expectations Banking Details: FCA account details: Stanbic Bank: Account name: College of Health Sciences UZ: Account number 914 000 1014 306, Branch: Parklane. ZWL account details: Stanbic Bank Parklane Branch, Acc number 914 0000 6695 62 Ref: Health Research Ethics Course: March 2020 For further information, or to secure your booking please contact: Tel: +242 708020 Email: rsc sacoreoffice@gmail.com cc pure.chandiwana@gmail.com or +263 775 495 566NameSubmit