Registration form MICROFIN CONSULT LIMITED WORKSHOP REGISTRATION FORM Kindly complete in full (in legible handwriting or typed) and submit through: [email protected] Location Business Planning and Budgeting using Microfin (Excel-based budgeting tool) Windy Lodge, Winneba Date: 7th – 11th March, 2017 (All days inclusive) Time: 8:30am-5:00pm Closing Date for application 30th December, 2016 Payment deadline 15th January, 2017 Workshop Title: PERSONAL INFORMATION Title: Last name: First name: CONTACT ADDRESS Telephone: Fax: Email: MORE INFORMATION Job Title: Name of RCB/MFI: Geographical area of operation: Nationality: Gender: Male Female What are your reasons for applying for this workshop? Please state in the box below your expectations at the end of the workshop. Workshop Fee: Subsidized Fees: Representation Residential (USD) 1,500 (100) (250) International Participants Early Booking Discount* Partial Scholarship** *Only Available if payment received by 30 Jan 2017 **Available on first come, first serve basis, and based on the answers to the questions above Payments should be made to the Account below: Account Name: Microfin Consult Limited Name of Bank: Unibank, Kaneshie Branch-Ghana Account Number: 0410141524716 Swift Code: UBGHGHAC Registration:- Completed registration form should be set via email to : The Programme Coordinator [email protected] I confirm that the information which I have given in this application is complete and true. Signature Date Contact the following for further enquiries Cassandra Okudzeto – Training Coordinator - +233(0)24 245 3774 Ishmael Kwesi Otchere – Managing Consultant-+233(0)24 341 2668 Email: [email protected] Website: www.microfinconsult.com 2 3
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