Ahmed Al-Jaber Street, Plot 1 Commercial Bank Bldg.

, 2nd Floor Opposite Al-Awadhi Mosque Sharq, Kuwait Mail: PO Box 44818 Hawalli 32063, Kuwait

Phone: +965-2247-0091 Fax: +965-2247-0092; +1-202-776-7109 (in U.S.) Email: kuwait@amideast.org Website: www.amideast.org/kuwait

PROJECT MANAGEMENT PROFESSIONAL (PMP) TRAINING COURSE REGISTRATION FORM

To reserve your seat, please fill in the registration form and submit it to our office. This can be done in-person or via email / fax. Enrollment is limited to a specified number of participants and applications are accepted on a first come first serve basis. Placement in the course can only be guaranteed when the registration form has been completed and payment has been received.

SECTION 1: Registration Information

1. First Name

2. Last name / Family Name

3. Gender:

Male

Female

Date of Birth: Date Month Year

SECTION 2: Contact Information

1. Company Name: __________________________ 2. Mobile Phone

3. Office Phone

4. Fax Number

5. Email Address:

__________________________

6. Signature:

__________________________

11. Date: _____________________