Online Application to attend a First Aid Course with Emergency Assist 991
Welcome to the EA991 First Aid online application process for individuals.
(If you are a Company or Corporate organisation, then we ask that you please contact us directly by email - info@ea991.co.bw or call us on 390 4537.)

The application process will take you approximately 2 minutes to complete.

Please complete all the fields as requested, and take note that all fields marked with an * are compulsory and information is required.

It is important to select which First Aid Level you are applying for so that we can allocate you to this course.

After you have completed the application process, we will be in contact with you to confirm your details and to advise of the Training Dates and Venues.

If you are experiencing any difficulty or have queries regarding this application - please email info@ea991.co.bw or contact us on 390 4537.

By completing this application, you agree that you have willingly provided the information to EA991 and agree to abide by the terms and conditions.
Personal Info
Please provide the information of the person who will be applying for / completing the Driver Training Course
NAME *
SURNAME *
DATE OF BIRTH *
MM
/
DD
/
YYYY
Nationality *
Required
Omang / ID / Passport Number *
Gender *
Required
Contact info
Please provide your contact details so that we can keep in contact with you.
CELL NUMBER *
Other Telephone Number
EMAIL ADDRESS *
If you do not have an email address - why not sign up for a gmail account - so easy to do. Search for "sign up for a gmail account" and click on the search result - "accounts.google.com/signup"
EMAIL ADDRESS *
City / Town that you normally reside in. *
Preferred contact method *
Required
Payment details
Please provide us with your preferred payment option
Are you being sponsored for this First Aid training course? (Is someone else is paying for the Course) *
Required
Please indicate your preferred payment option *
Required
Next
Never submit passwords through Google Forms.
This form was created inside of EA991 Driving Academy. Report Abuse