Member/Account #:

Name:

Signature: Date:

Mailing Address:

Email:

City:

Country:

Trainee Code:

**Registrar Use Only**

Tel #:

Mobile #:

Computer Training Experience:

Project Expectations:

In Case of Emergency

Occupation:

Fax #:

Date of Birth:

IME �INSPIRE� Registration Form

CONTACT INFORMATION

PERSONAL INFORMATION

PROJECT REGISTRATION INFORMATION

I n s p i r i n g t o G r e a t n e s s

I would be willing to contribute towards the development and distribution of the E-Source Magazine. (Info would be made available )

K V L I F E L I N E F O U N D A T I O N

PLEASE FILL OUT IN BLOCK LETTERS

EMPLOYED STUDENT BUSINESS OWNER Other

The IME Inspire project registration fee: $ 50.00 ( for residents and environs) registration fee: $ 200.00 (non-residents)Terms and Conditions: 1) Please note the registration fee is non refundable; 2) Session Dates and Syllabus may vary at the discretion of KV Lifeline Foundation; 3) Evaluation processes and All selection decisions rest in the hands of KV Lifeline Foundation; 4) Individuals would have the option of using laptops and other equipment, as such individuals would be held responsible for any damages while item in that individuals care; 5) Individuals must respect all persons within these sessions; 6) The project secretary should be contacted for any concerns, questions as sessions progress; 7) The Project Administrative Team: 1) PROJECT DIRECTOR 3) EDUCATION DIRECTOR 2) PROJECT ADMINISTRATOR 4) IT SUPERVISOR

Tel.: Relationship:

Signing hereunder means you understand and agree to the terms and the conditions of this project and the registration information communicated.

Y Y Y Y M M D D

Registration Code:

Business Development Employment Freelance Artist

NGO Support Further Training as Graphic Designer

Payment Information:

Registration Fee must be paid upon return of this form Receipt No.: Receipt No. Cheque No. Transaction No.

REGISTRATION FEE: $ 50.00 $ Cash Cheque Bank Deposit

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