Registration Form

Registration Form

Petroleum Training Services, Indonesia
Enrolment Information
Course Name:
Course Date:

DayMonthYear
Date
Course Location:
Candidate Information:
Name

First NameMiddle NameLast Name
Date of Birth:

DayMonthYear
Date
ID or Passport Country of issue: (e.g. Malaysia, Indonesia, Thailand)
ID or Passport Number:
ID or Passport Date of Issue:

DayMonthYear
Date
ID or Passport Expiry Date:

DayMonthYear
Date
Home Address:
Mobile Phone Number:
Email Address:
IWCF CR Number:
(Please get the CR number at https://www.iwcf-forum.org/newcandidate)
Job Position:
Current Company: (if self-funded mark as N.A)
Company Address:
Company Telephone:
Additional requirement:

Other
REMARK 1: All participants have to send / Following details as below.
REMARK 2: Do you have any special requirement you wish to identify?

Other
Payment Method:

Contact FMU for payment options:

PT Fritmandiri Utama, JL. Gandaria 3 no. D6, Jakarta Selatan, Indonesia, 12130
Telephone Number: +62 217 269 214
Email: fmu@fritmandiri.co.id
Website: www.fritmandiri.co.id
The cancellation must be made and received 15 days or more prior to the course. One half of the registration fee must be paid by those registrants who cancel less than 15 days before the program.

The Registration will confirm after the payment!!!
Should be Empty:

Enrolment Information