2009 TRAINING - Cummins.com

2010 REGISTRATION FORM
CUMMINS TRAINING AND EDUCATION CENTRE, DAVENTRY, ENGLAND
Please complete, sign, date and return this form by fax on 01327 886033 OR post to MAVIS LAMB.
CUMMINS LTD, ROYAL OAK WAY SOUTH, DAVENTRY, NORTHANTS. NN11 8NU, ENGLAND.
TEL: 01327 886400. EMAIL mavis.y.lamb@cummins.com
(One form per Applicant – Please print or type) (Photocopies of this form are acceptable)
PROMOTION ID NO:
WHAT TECHNICAL SPOKEN/WRITTEN LANGUAGE DO YOU REQUIRE THE COURSE IN?
COURSE NAME: #
(APPLICABLE ONLY IF YOU HAVE ATTENDED A CUMMINS COURSE PREVIOUSLY)
ENGLISH/OTHER (Please Specify)
COURSE DATE: NO. OF DAYS: COST:
(£150 PER PERSON, PER DAY + VAT)
APPLICANT’S DETAILS:
APPLICANT’S FIRST NAME:
SURNAME:
(FOR CERTIFICATE PURPOSES)
POSITION IN COMPANY:
TITLE: MR/MRS/MISS/MS/DR
COMPANY:
ADDRESS:
COUNTRY:
PHONE:
POST CODE:
FAX:
EMAIL ADDRESS:
Please ck appropriate box applicable to your organisaon:
Cummins Distributor Cummins Dealer OEM End User/Customer
If you have a Cummins Quick Serve Online (QSOL) subscripon, please enter your WWSPS 5 digit service
provider code (SPC)
INVOICING DETAILS: PAYMENT MUST BE MADE PRIOR TO THE COURSE START DATE, PLEASE PAY BY CHEQUE, BACS OR CREDIT CARD
CUMMINS BANK DETAILS OVERLEAF
WHO IS PAYING FOR THE COURSE?
INVOICE CONTACT NAME:
INVOICING ADDRESS:
COUNTRY:
PHONE:
POST CODE:
FAX:
E-MAIL ADDRESS:
VAT NUMBER:
COPY OF PURCHASE ORDER ATTACHED
WITHOUT THIS WE ARE UNABLE TO PROCESS YOUR FORM
I AGREE TO ABIDE BY THE TERMS AND CONDITIONS SET OUT ON THE BACK OF THIS FORM
SUPERVISOR/MANAGER NAME:
SIGNATURE:
DATE:
SPECIAL REQUIREMENTS EG: DIETARY, ENTRY VISA, DISABILITIES, SPOKEN LANGUAGE:
Data Protecon
The informaon set out above constutes personal sensive data under the Data Protecon Act (“The Act”) and will be processed and retained strictly in
compliance with The Act, relevant Codes of Pracce and the Cummins Data Protecon Policy.
FORMS
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