Complete the form to enrol/register a course.

1. Note that by submitting this form, you consent to the collection, collation, processing, and storing of such information and the use and disclosure of such information for the purpose of training in accordance the HISP Privacy Policy. *

I have read and accept the above statement

2. Title *

3. Initials *

4. First Name(s) *

5. Surname / Last Name *

6. Gender *

7. ID Number / Passport Number *

*Note: This is the number that will appear on your certificate

8. Date of Birth *

9. Disability *

10. Cell Number *

*Note: Please provide the number that we can use to contact you during training

11. Email Address *

Confirm Email

12. What course are you registering for? *

13. Course Start Date *

14. Employment Status *

15. Employer Name

16. Field of Work

17. Position

18.Employment Location

I work in South Africa
I work outside South Africa

19. Level at which you work

20. Province

*Note: If you work in more than one province, then select 'Not Applicable'.

21. District

*Note: If you work in more than one district, select 'Not Applicable'

22. Sub-District

*Note: If you work in more than one sub-district, type 'Not Applicable'

23. Facility (type in)

*Note: If you work in more than one facility, type 'Not Applicable'

HISP Lab

HISP Lab

Course Enrolment/Registration

HISP Privacy Statement