REGISTRATION FORM

(Fax to 03-7982 9811 or email: mbam14@mbam.org.my/mbam13@mbam.org.my )

REGISTRATION & CANCELLATION POLICY

RegistrationWith CIDB Green

Card RM/PaxWithout CIDB Green

Card RM/PaxPax Total (RM)

MBAM Member

Non MBAM

Member

Cheque No: ________________________________ for the amount of RM ___________________

All payment should be made payable to:MBAM Training Services Sdn Bhd MAYBANK Account No: 514-114-435-808

Due to the limited seats available, acceptance is based on first-come-first-serve basis. Upon issuance of confirmation note, no

cancellation request will be entertained. However, a substitute participant is welcome without additional charges. Please extend

a copy of your Bank-in slip to MBAM Secretariat as a proof of payment to enable official receipt to be issued. Advance payment

is required for guaranteed participation and must reach MBAM Secretariat

Name of Company: ____________________________________________________________________Address: ____________________________________________________________________________

____________________________________________________________________________Contact Person: ___________________________ Email: ______________________________Phone No.: _______________________________ Office No.: __________________________

We wish to register the following participants:-

1. Mr/Ms ______________________________________ Designation: _________________________NRIC: ______________________________ CIDB Green Card Expiry Date: ______________________Tel or H/P No: _________________________ Email: ______________________________________JKKP Reg. No: ____________________________________ (if any)

2. Mr/Ms ______________________________________ Designation: ________________________NRIC: ______________________________ CIDB Green Card Expiry Date: ______________________Tel or H/P No: _________________________ Email: ______________________________________JKKP Reg. No: ____________________________________ (if any)

3. Mr/Ms ______________________________________ Designation: ________________________NRIC: ______________________________ CIDB Green Card Expiry Date: ______________________Tel or H/P No: _________________________ Email: ______________________________________JKKP Reg. No: ____________________________________ (if any)

Company Stamp:

MBAM Training Centre6-2, Jalan 1/109E, Desa Business Park

Taman Desa, off Jalan Klang Lama 58100 Kuala Lumpur 8.30 am – 5.00 pm

MBAM

DESIGNATED PERSON (DP) TRAINING ON CONCRETING

Intake : Training Date :

All fees are Inclusive of 6% Service Tax *Special CIDB Subsidized Course Fee only Eligible for : Valid CIDB Green Card Holders and

those who are working with A CIDB Registered Contractor ( G1-G7 )