Naam en Van / Name and Surname:

Wildsplaas / Game Ranch:

Posadres / Postal address:

Taalvoorkeur / Language preference:

E-Pos adres / Email address:

Faks no / Fax nr:

BTW nommer / VAT number:

Besigheidsnaam / Business Name:

Tel nr (W):

Selfoon no / Cellphone nr:

Ek stel belang in / I’m interested in:

Kursusdatum voorkeur / Preferred course dates

Afrikaans

English

2-dag kursus / 2-day course

3-dag kursus / 3-day course

Aankoop van passiewe vangkraal / Purchase of passive capture boma

Aankoop van paalspuit / Purchase of pole syringe

Aankoop van medikasie / Purchase of medication

(VOLGENDE KURSUS DATUM NOG NIE BEPAAL)

(NEXT COURSE DATE NOT DETERMINED YET)

BESPREKINGSVORM / BOOKING FORM

Eko Wild Passiewe Wildvangkursus / Eko Wild Passive Game Capture Training Course

Met akkommodasie / With accommodation

Sonder akkommodasie / Without accommodation

VRYWARING DEUR KURSUSGANGER / INDEMNITY BY COURSE PARTICIPANT

(Word geteken met aankoms / To be signed on arrival)

Ek, ___________________________________ met ID nommer ________________________, die ondergetekende, vrywaar hiermee Eko Wild (Edms) Bpk en enige van sy personeellede, asook geassosieerde besighede, maatskappye, plaaseienaars waar kursusse plaasvind en hulle personeel van enige skade, beserings of dood wat ek/ons mag oorkom tydens die hele verloop van die kursus, of mag voortspruit uit my deelname aan die kursus. Ek neem kennis van die feit dat praktiese werk en blootstelling aan wilde diere gevaarlik mag wees.

I, ____________________________________ with ID number _________________________, the undersigned, hereby indemnify Eko Wild (Pty) Ltd or any of its personnel, associated businesses, companies, farm owners where courses take place or any of their personnel from any damage, injury or death which may occur or result during the cause of my/our participation of the training course to be held. I take note of the fact that practical work and exposure to wild animals could be dangerous.

Geteken te .................................. op hierdie .......... dag van ..................................... 20....

 

__________________________                                                               _________________________

                Kursusganger                                                                                           Getuie

Signed at ..................................... on this .............. day of ....................................... 20....

 

__________________________                                                               _________________________

                Course participant                                                                                   Witness

Please complete form, print it and fax it to

0866 472 608

Vul asseblief vorm in, druk en faks na

0866 472 608