Young Engineers Entrepreneurship Club, Africa

Office Address: House 27, Road 314, 17 Sentel Plaza, No 24 East West Road
Trans Amadi Garden Estate Odili Road, Port Harcourt, Nigeria
Port Harcourt, Nigeria Email: info@oiltrain.org or lagos@oiltrain.org
Email: info@yeecafrica.com Phone: 08060646490, 07036248614
Phone: 08090941660, 0903441366

OIL AND GAS INDUCTION /TRAINING FORM

(Please fill and tick where appropriate)
Please Attach
Recent Passport

BASIC INFORMATION

Name: ____________________________________________________________________________________
Surname Middle name Last name

Sex: Male Female

Date of Birth: ____________________________

DD MM YYYY

State of Origin: ___________________________

Marital Status: Single Married Divorced Others

Current Residential Address (should include state of residence):

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Phone number(s): __________________________________________________________________________

Email Address: _____________________________________________________________________________

YEEC Africa… Reducing Unemployment, Developing Africa.

 EDUCATION (POST-SECONDARY)

Name of Institution ________________________________________________________________________

Discipline (course of study):___________________________________________________________________

Grade/Class of Graduation (or current grade):____________________________________________________

Year of Graduation (or expected year of graduation):_______________________________________________

Any other degree or Specialized certification (briefly describe in the box below):

YEEC AFRICA INFORMATION

Are You a Member of YEEC Africa? Yes No

Membership Category: Student Graduate Professional Fellowship Cooperate

Membership Code: Y C - _ _ _ _ _ _ _ _

Training / Programme of Interest: (kindly pick from the options available on the site)

________________________________________________________________________________________

Attestation:

I ……………………………………………, confirm that the above information is correct to the best of my knowledge. I also attest that all through the period of this training, I will
be of good conduct in line with the values of YEEC Africa and the governing laws of the land, and where I behave otherwise, m y training should be stopped and all
benefits withheld.

Signature…………………. …………………. Date……………………………….

YEEC Africa… Reducing Unemployment, Developing Africa.