Safety 360 Registration Form

SAFETY 360 REGISTRATION FORM
Reference Number: {referenceNumber}
Location*

Parkcity Everly Hotel - Bintulu, Sarawak: 3/12/2024
1. WEIL Hotel, Ipoh Perak: 22/10/24 REGISTRATION CLOSED

2. Hotel Seri Malaysia, Kangar Perlis: 24/10/24 REGISTRATION CLOSED

3. Swan Garden Resort Hotel, Melaka: 29/10/24 REGISTRATION CLOSED

4. Royale Chulan Hotel, Negeri Sembilan: 7/11/24 REGISTRATION CLOSED

5. Zenith Hotel, Kuantan Pahang: 24/10/24 REGISTRATION CLOSED

6. Resorts World Kijal, Terengganu: 22/10/24 REGISTRATION CLOSED

7. SICC, Kota Kinabalu: 5/12/24 REGISTRATION CLOSED

8. E&O Hotel, Penang: 21/10/24 REGISTRATION CLOSED

9. Raia Hotel, Alor Setar, Kedah: 23/10/24 REGISTRATION CLOSED

10. Trove Hotel, Johor Bharu, Johor: 28/10/24 REGISTRATION CLOSED

11. Renai Hotel - Kota Bharu, Kelantan: 19/11/2024 REGISTRATION CLOSED

12. Geno Hotel - Subang Jaya, Selangor: 6/11/2024 REGISTRATION CLOSED
Company*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Industry*
Person in Charge for Registration
Person In Charge Name*
Mobile Number*
Email *
Particular*
** The information provided will be used for certification generation and HRDC claim purposes.

Particular

	Name of Participant(s)	I/C No.	Mobile Number	Designation	Email	Gender	Vegetarian
Name of Particpant (s)
Name of Particpant (s)
Name of Particpant (s)
Name of Particpant (s)
Name of Particpant (s)

What is the most common PPE used by you or your organization?
Head ProtectionEye & Face ProtectionHearing ProtectionRespiratory ProtectionHand ProtectionBody ProtectionFoot ProtectionFall ProtectionTraffic SafetySignage & LabelsLockout & TagoutElectrical ProtectionFloor SafetyFire ProtectionGas Detection & Portable InstrumentsEmergency Eyewash & ShowerSafety StorageSpill Control ProductOther
Package (Excluded 8% SST))*

CON360-1 RM 499/ pax (Individual - Less than 3 pax)CON360-2 RM 1,996/ group (Group - Buy 4 Free 1)CON360-3 RM 350/ pax (Student)
Payment Method*

Electronic Bank In (FPX)Credit CardGrab PayHRDC Claim (SBL KHAS)
Course Details

Course Title: Safety360 EHS Conference 2024
Course Serial Number: 10001465889

Click here to download event documents.
Click here to proceed payment:
Option 1: Non-Student (Individual)
Option 2: Non-Student (Group)
Optoin 3: Student
Customer ID
Remark:
Item Code
Total Number of Participants
HRDC Approval Number
VIP = 3, MCAD = 2, New Customer = 1, Old Customer = 0
Cert Issuance

Yes
Proof of Payment (If you are a student, please also attach a photo of your Student ID card)

Cancelof
By registering for this event, you acknowledge and agree to the following terms:

1. Personal Information: The information you provide will be used solely for event-related purposes, including communication about the event and future updates. Your data will not be shared with third parties without your consent.

2. Full Payment Commitment: If the company does not receive disbursement from HRD Corp, the full payment must be made to Safetyware EHS Consultancy Sdn.Bhd. before or on the event date. A late payment fee may apply for payments not made within the specified period.

3. Replacement / No Show: No replacement or refund is allowed for the program as per Safetyware EHS Consultancy Sdn. Bhd's guidelines. No-show fees may be charged if the registered participant does not attend. In case where a participant cannot attend due to an emergency, a written explanation must be provided within 48 hours after the event for HRD Corp's consideration.

By clicking “Register,” you confirm that you have read and agree to this disclaimer.
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SAFETY 360 REGISTRATION FORM