EHSE Student Registration Form

Title

Student Name(As per Id)

Mobile

Date of Birth

E-mail Id

Address

Post code Country

Course Applied

Office Use Only

Training Venue

Courses Approved

Training Fees

Course Date

Exam Location

Exam Date

Student Number

PLEASE NOTE THAT YOUR SIGNATURE BELOW FORMALLY BINDS YOU TO OUR YOUR PAYMENT TERMS &
CONFIRMS THAT YOU HAVE READ & UNDERSTOOD.

EHSE reserves that right to refuse admission if payment is not received.

Course Fee should be completed within fifteen days from class started.

Certificate/ Results/ Hall tickets will not be processed or released unless payment is made in full.

I confirm my acceptance of the EHSE terms & conditions of service and the above arrangements and accept
that this booking form represents a formal order for the above course.

Signed : Date: