Affix 1

passport
EIR-INTERWEAVE NIGERIA OFFICE size
Behind INEC Quarters,Guzape District,Asokoro,Abuja photograph
TEL: +2348121829033 E-MAIL:eir.interweave@gmail.com

EIR-INTERWEAVE SUCCESS AMBASSADOR COURSE APPLICATION FORM

Please complete this form in full, by computer or by hand, printing clearly in ink.
If additional space is required, attach a separate sheet, indicating the section number
That it refers to. Return 1 original and 2 additional copies of the form in hard copy to: N5, 000 or $14

Name __________________________________________________________________  Male  Female

(Last) (First) (Middle)

Address ______________________________________________________________________________________
(City) (State)
E-mail Address ________________________________________________________________________________

Home Phone ______________ Work Phone ________________

Birth Date _________________ Marital Status: Single ____ Married ____ (__________________________)
(Maiden name)
Have you ever taken a course on business entrepreneurship? No ___ Yes ___ When? _______Student ID _______
(if known)

Please register me for the following:

Workshop Amount
Number Workshop Title & Date Enclosed
1
EIR-INTERWEAVE MBS BUSINESS CERTIFICATION TRAINING

TOTAL AMOUNT ENCLOSED FOR REGISTRATION $

(Amount paid in words:……………………………………………………………………………………………)

Registration FEES Name…………………………………………………………………………..$14 or N5,200

(Non refundable) Payable to Ensign Integrated Resources, Account No: 227-185-6019, FCMB PLC
(Naira) The remaining fees of $50 or N18,000 for course materials and refreshment for the duration of the course
will be paid upon the receipt of your letter of engagement. If the training is canceled by EIR-INTERWEAVE, your
deposit and any balance paid will be refunded. Course Materials must be paid in full on or before the first day of the
Training upon receipt of your letter of engagement. All checks should be made payable to Ensign Integrated
Resources. ATM payment may also be used for all payments. Confirmations of payments send via E mail one week
same week payment was made.
 Affix 1
passport
EIR-INTERWEAVE NIGERIA OFFICE size
Behind INEC Quarters,Guzape District,Asokoro,Abuja photograph
TEL: +2348121829033 E-MAIL:eir.interweave@gmail.com

REGISTRATION OPTIONS:

1. By mail:
Mail completed registration form and non-refundable evidence of registration payment deposit for
engagement to:eir.interweave@gmail.com or to the corporate office as stated above.

2. By phone:
Call the Office at 08121829033 and register. A non-refundable deposit by debit/ATM card is required.

CANDIDATE'S STATEMENT

I declare that the above information is true and correct. I also declare that, to the best of my knowledge, my health
allows me to undertake the proposed study programme. I also take note that if my application is accepted I shall have
to undergo a training and all training materials will be at my own expense, according to instructions received from
EIR-INTERWEAVE, and that my participation in the course will be conditional upon the satisfactory results of this
examination. I also declare that I will be returning to my current employer, on completion of the course.

CANDIDATE'S SIGNATURE DATE

How did you learn about the course?---------------------------------------------------

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