Permaculture Design Certificate (PDC) Course Registration
Event Timing: July 19th till 31st, 2018 (excluding Saturdays and Sundays)
Event Address: 14 Ceres Road, Bergvliet, CAPE TOWN, South Africa
Contact us at +27 (21) 712 9908 or jacqueline@inspirepermaculture.com
Full Name *
Identity or Passport Number *
Birthday
MM
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DD
/
YYYY
Address
Email *
Organization *
Profession
Mother tongue
Any additional languages spoken
Home Number
Work Number
Mobile Number
Emergency contact details - in case of an emergency who should we contact ?
Emergency Contact Number
Do you have any medical conditions or allergies? Please elaborate:
Dietary restrictions *
Tell me a little bit about yourself:
Briefly describe the land to which you would like to apply Permaculture. Provide address/ GPS coordinates if you wish.
Why do you want to do this Permaculture Design Certificate (PDC) Course and what do you hope to get out of it?
Please submit a copy of your ID/ Passport for your certificate *
Required
Preferred Name for Certificate
Payments via EFT R6 500: J Edmiston, Standard Bank, Constantia, Account 27-162-472-8, REF: Name & Surname
Proof of Payment: Upload or email jacqueline@inspirepermaculture.com
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