Executive MBA Form

1. PERSONAL DETAILS
Title *
Surname *
First Name *
Address *
City/Postal Code: *
Telephone Number *
Fax Number
Email Address *
Cell Number
Date of Birth
Place of birth
Nationality *
Int'l Passport No:
2. ORGANIZATION
Organization *
Position *
Telephone Office *
Fax Number *
Email Address *
Postal Address *
Physical Address *
Give a short description of the most important products and/or services of your organisation: *
Who is responsible for Training and Development within your organisation:
Name *
Gender *
Telephone Number *
Email Address *
Address *
3. EDUCATION

Give a chronological overview of studies/courses followed at Polytechnic, University & other Institutions *

Date	Education/Professional Institute	Qualification	Actions

date: mm/dd/yyyy

Management Courses/Trainings

institute	Programme	Period	Actions

Work Experience (Describe present position first) *

Date	Employer	Job Titile	Responsibility	Actions

Other experience of responsibility and achievements
5. YOUR ACTION LEARNING GOALS
What do you expect to gain from the programme personally and for your employer *
Who referred you towards enrolment for the Executive MBA Programme?
Name

First

Last
Phone Number
Personal computer and quality Internet connection are essential requirements of the school, what access do you have to a personal computer and Internet connection? *
6. PAYMENT OPTIONS

Kindly tick the appropriate payment structure
Registration Fee *

N100,000
Payment Options *

One-off payment (N6,000,000 (less 5%) Two-times payment (N,3000,000 (less 2.5%) Four-off payment (N1,500,000 less 1.25%) Bi-Monthly (N500,000) Monthly (N250,000)
7. INVOICE ADDRESS
organization/Self *
Attention: *
Position: *
Telephone Number *
Email Address *
Postal Address *
City *
Postal Code
Additional Info

Please upload the below items to complete your application
Passport Photograph *
Select File(s)
Certified copies of previous qualification *
Select File(s)
Certified copy of identify *
Select File(s)
8. GENERAL TERMS AND CONDITIONS
I have read and agree to the Terms and Conditions and Privacy Policy

1. PERSONAL DETAILS