Name Please enter your first name Surname Please enter your surname Cellphone Please enter your Cellphone number Email Please enter your email address What suburb do you live in? Please let us know what suburb you live in What school do you attend? Please let us know what school you attended Where did you hear about EBS Mathology Clinic? -- Select -- Email Facebook Google Newspaper Advert Street pole adverts Trailer Adverts Flyer at exam venue Flyer at school School Colleague Friend Other Please let us know where you heard about Edge Parent/Guardian Contact Number Please give us your Parent/Guardians Phone number Parent/Guardian Email Address Please give us your Parent/Guardians Email address The total cost for each Mathology programmes are R2500.00 or R5000.00 Respectively. Amounts are payable upfront or over terms. Please indicate which Mathology Maths Mark Up Clinic you will be attending: Select your course Grade 10 IEB - Self Study (R2500.00) Grade 10 CAPS - Self Study (R2500.00) Grade 11 IEB - Self Study (R2500.00) Grade 11 CAPS - Self Study (R2500.00) Grade 12 IEB - Self Study (R2500.00) Grade 12 CAPS - Self Study (R2500.00) Grade 12 IEB - Self Study + Online Learning Video Support Package (R5000.00) Grade 12 CAPS - Self Study + Online Learning Video Support Package (R5000.00) Please select a course Select your payment term Upfront 5 Instalments 10 Instalments Please select a course Initial Pament Electronic Funds Transfers can be made to: Account name: EBSDOTCOZA (Pty) Ltd Bank Name: FNB Branch Name: Sandton City Branch Code: 254605 Account No: 62872117190 Account Type: Current Account Reference: Name and Surname Please attach proof of payment when submitting this form. Please attach your Proof of Payment in either PDF, JPG or PNG I/We consent to receiving marketing material by electronic methods of communication from EBSdotCOZA - Edge Yes Invalid Input Submit Ts & C’s: Costs are not refundable. These costs do not include additional tuition or interaction over and above the offering with lecturers. I fully understand the type of programme for which I am enrolling at EBSdotCOZA - Edge
