Enrolment Form - Neuroscience of Leadership Program

Name
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First Name*
First Name
Last Name*
Last Name
Date of Birth*
Month
Day
Year
Email Address for Student Platform*
Mobile Phone*
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Company
Job Title
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Emergency Contact
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1. All information in this enrolment form is correct to the best of my knowledge. 2. I acknowledge that it is my responsibility to advise NeuroCapability if any of my personal information changes, including contact details. 3. I have received a copy of NeuroCapability’s Training Participant Handbook and read the policies and procedures in relation to: a. Complaints and academic appeals b. Fees and refunds, and c. Support and guidance services available to me. 4. I will abide by NeuroCapability’s Code of Conduct and all terms and conditions as stated in the Training Participant Handbook.*
- By submitting this form, I acknowledge and agree to the following conditions:
1. All information in this enrolment form is correct to the best of my knowledge.
2. I acknowledge that it is my responsibility to advise NeuroCapability if any of my personal information changes, including contact details.
3. I have received a copy of NeuroCapability’s Training Participant Handbook and read the policies and procedures in relation to:
a. Complaints and academic appeals
b. Fees and refunds, and
c. Support and guidance services available to me.
4. I will abide by NeuroCapability’s Code of Conduct and all terms and conditions as stated in the Training Participant Handbook.

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Neuroscience of Leadership Program Enrolment Form