Pease complete this form and retum to i eso aces M PECB 5 | ss KEVOND RECOGNITION PECB Ta 9619-7135 ‘raining Your Partner REGISTRATION FORM Designation/Jabatan Course Tittle Name of Participant (s) / Nama peserta Course Date (s) 1 _Michoci yah 84 L6- Beat Greer of VPE 6.5 gahof 2, _Yohan Criscionto Arc.tiga Enginariny Comrur of voats 2aho/is 7 = 4 5. Company Name CL. Gace Hfech Address Due Tnclostrtal Pore arco Boe c M6.9 — etlan Coner Linecttutiass ; _ Wlanuhec brag Contact person Vide 7 tndyen Designation - A/c» Gawed Manage Phone No. (468.888) Fax no. : 2198 Goa ec) Email: | qcosOiplr.co.va Gy (468 906 } 24 podyson@ (tyke coil For official use only (to be completed by Trampil Sistem Manajemen Training Dept) Remark Confirmed by Tem & Condition ‘+ Please complete this registration form and return to us emailto : {raining@irampilsister com, rahmatarifwibawag@omailcom + You may use your organization Purchase Order to replace this form by fil the Name, Course No, Course Dato,Contacl Person, Phone No, and E-mail Payment + Full payment should be made 2-weck prior to commencement ofthe training course + All payment should be transferred to Rahmat Arif Wibawa, Bank CIMB Niaga Account : 8650104908487 or Bank Mandiri ‘Account 1090014668024 ‘+ For other bank registration , please check to Trampil Sistem Mangjemen officer Invoice will be given to participant during training day Venue ‘+ Venue wil be informed to contact persons Withdrawal and Replacement * Once registration is confirmed, no cancellation is alowed; otherwise full fee will be payable. If the registered participant unable to attend the training, another participant to change is allowed or ifnot, cancellation fee below are applied + Cancellation Fee nas ‘© Less than 1 week before commence: 100% from training fee mye “iota ofr ch Name Eiders all Geter. antiger Designation ‘TSM-03-001Rev |. Eifective 17/05/2018