Workshop Registration Form

Cisco Entrepreneur Institute

Participant Information

*Full Name:	*Date of Birth:
Company Name:	Home Phone:
*Title:	*Mobile Phone:
Website:	Work Phone:
*Education: Degree & Year	*Email:
In which sector do you want to start a business or already own a business?
Please list any professional associations, groups, clubs, or organizations you belong to:

*Choice of workshop you would like to register in: Choose an item.

*Preferred Social Networking Site: Click here to choose

*English Proficiency:

Speaking: Click here to choose	Reading: Click here to choose	Writing: Click here to choose

Payment Details

Payment to be made: Method of Payment:

For more information about the registration fees and schedules of individual workshops, please visit our website

Signature: ________________________________________ Date: _____________________

To reserve your place, please submit this form by email to (cisco.facilitator@gmail.com) no later than two weeks before the commencement of the workshop

11 Fahoud Street, opposite Qurum, Natural Park.

Telephone: +968 2456-1727 / +968 96725400 Fax: +968 2456-4457

Email: salbarami@amideast.org

Website: www.amideast.org/oman