Personal Information

Full Name

Your Email

Phone Number

WhatsApp Number (If Different)

State Of Resident

Local Government Area (LGA)

Home Address

Date Of Birth

Gender (Male/Female)
MaleFemale

Full Name

Relationship

Phone Number

Address

Passport (Required For Your Certificate)

Educational & Skill Qualifications

Highest Educational Qualification
FSLC – First School Leaving CertificateSSCE / WAEC / NECO – Senior Secondary Certificate ExaminationNABTEB – National Business and Technical Examinations BoardOND / ND – Ordinary National DiplomaNCE – Nigerian Certificate in EducationHND – Higher National DiplomaBSc / BA / BEng – Bachelor’s DegreePGD – Postgraduate DiplomaMSc / MA / MEng – Master’s DegreePhD – Doctor of Philosophy

Do you have any technical or vocational training? (Yes/No)
YesNo

If yes/no, please explain

Do you have any experience with refrigeration or air conditioning? (Yes/No)
YesNo

If yes/no, please describe briefly

Training Preparation

Please select your preferred training days (Contact us via whatsapp for any changes)
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Do you have the listed practical tools? (Yes/No)
YesNo

If no, would you like Iceman-Tech to help you source them? (Yes/No)
YesNo

Will you require accommodation? (Yes/No)
YesNo

Will you come with your own stove/boiler? (Yes/No)
YesNo

Do you have safety wears? (Yes/No)
YesNo

Payment Confirmation

Amount Paid

Date of Payment

Method Of Payment
Direct BankAppPosInternet Transfer

Upload Pop (10mb Max)

Declaration

I hereby declare that the information provided above is accurate to the best of my knowledge. I understand that submission of this form along with payment confirmation is required to secure my spot in the training program.
(If you need any help or have a question, please contact us via
WhatsApp to +2348037467258)