African Snakebite Institute – Presentation and Demo Booking form

Please complete the Presentation Booking form below, in order for us to load all your company information onto our system.

Please note, a completed booking form and an official company purchase order (or payment in advance) are required in order for us to confirm presentation dates.

Course: (Please choose relevant option from drop down)*
Date of presentation:*
DD slash MM slash YYYY
Starting Time:*

: Hours

Minutes

AM/PM
Client / Company Name:*
Venue physical address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Choose Location*
We hereby grant ASI permission to bring live venomous snakes (for snake demonstration) onto the premises address listed above. (Snakes to be kept securely contained at all times, except during the actual demo session)*
- Agree
- Disagree
Gate Name:
Internal Venue Name:
Does the venue have a projector?*
- Yes
- No
Does the trainer need to attend a site induction?*
- Yes
- No
Contact Person On-site:*
First Last
Mobile Number:*
Tel Number:*
Alternate Contact Person On-site:
First Last
Mobile Number:
Tel Number:
Invoicing Information:
Company Name: (As it must appear on invoice)*
Postal Address:*
VAT Number:
Purchase order number:*
Person Responsible for Payment:*
First Last
Email address:*
Phone number:*
Confirmation:
By completing this form, I hereby confirm that I am duly authorised to dispense above company information.*
- Agree
- Disagree
Form completed by:*
Email Address:*
Phone
Date*
DD slash MM slash YYYY

African Snakebite Institute – Presentation and Demo Booking form

Invoicing Information:

Confirmation:

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