DESIGN THINKING OPEN CLASSES

Please proceed to fill in this form if you are signing up with 3 pax and below. For any sign-ups beyond these numbers, kindly contact kamaliah.kasmaruddin@genovasimalaysia.com

Name (as per IC)

Preferred Name on Tag - this will be the name on your nametag, keep it to one word!

Gender

Age

NRIC number

Position

Department

Organisation

Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Number - please leave a number where you will be contactable, as WhatsApp will be the main mode of communication for the duration of this programme

+601XXXXXXX

Office Number

+603XXXXXXXX

Office Email Address

example@example.com

Alternative Email Address - in case we cannot contact you via your office email address

example@example.com

Highest Education Level

Field of Study

Ex: Mass Communication, Marine Biology, Medicine, etc.

Meal Preference

Name (as per IC)

Preferred Name on Tag - this will be the name on your nametag, keep it to one word!

Gender

Age

NRIC number

Position

Department

Organisation

Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Number - please leave a number where you will be contactable, as WhatsApp will be the main mode of communication for the duration of this programme

+601XXXXXXX

Office Number

+603XXXXXXXX

Office Email Address

example@example.com

Alternative Email Address - in case we cannot contact you via your office email address

example@example.com

Highest Education Level

Field of Study

Ex: Mass Communication, Marine Biology, Medicine, etc.

Meal Preference

DESIGN THINKING OPEN CLASSES

Programme Selection

Participant's Information

Participant #2 Details

Participant #3 Details

Billing Information