CERTIFIED BUSINESS LEADERSHIP PROGRAMME
COURSE REGISTRATION FORM Please complete this form and send it to: The Kenya Institute of Management | Luther Plaza, 2nd Floor, Nyerere Road: P.O. Box 43706 00100 GPO, Nairobi, Kenya Tel: 020 2535276 • Email: firstname.lastname@example.org or Margaret on email@example.com • Website: www.kim.ac.ke
Name of the Participant: Telephone: Address: Email: Academic Qualifications:
Work Experience: Current Organisation: Position Held:
Payment Details Cheque Details: In favour of the Kenya Institute of Management Cash Transfers: Commercial Bank of Africa - Wabera Street Branch Account No.: 6425720016 Swift CODE CBAFKENX Investment Kshs: 128,500/-, Inclusive of meals, lunch & study materials Note: Course Fees should be paid in full before the course starts. All cheques are payable to The Kenya Institute of Management.
Promoting Excellence and Integrity in Management Practices Since 1954