Synerquest Management

Consultancy Services, Inc.
in coordination with DOLE Accredited Safety Training Organization

REGISTRATION FORM
Email to: ibonropr@gmail.com ibonrop@ymail.com

Course:
Training Dates:
Mark X

BOSH - Basic Occupational Safety & Health (40 hours)
Mon to Fri Month: Date, from: to

5 Saturdays From, Date: To, Date Please refer to the schedule provided. TRAINING VENUE University Hotel, UP Diliman, QC Skyway O&M, Paranaque City Regular, 12% VAT Inclusive
PEZA &/or VAT Exempt Companies

Registration Fee:
Mark X

10,080

9,000

Name of Participant # 1 Company Name: PEZA &/or VAT Exempt Company: Yes Address: Tel No.: E-mail Address: Name of Participant # 2 Company Name: PEZA &/or VAT Exempt Company: Yes Address: Tel No.: E-mail Address: Person Authorizing Registration:
Mark X

Personal No / N.A Cell 2:

Cell 1:

Personal No / N.A Cell 2:

Cell 1:

Name: Designation: Check Company will Pay Pay on Day 1 of training Personal

Payment Mode:

Cash Bank Deposit

FILL-UP and EMAIL/SUBMIT YOUR REGISTRATION FORM to reserve your slot/s. We will send you a location
map upon receipt of this Registration Form. Full payment of the registration fee may be paid on day 1 of the training seminar. If paying by check, make it payable to Synerquest Management Consultancy Services, Inc. If payment is made thru bank, BPI CA Acct # 1991-0088-68 e-mail a scanned copy of the deposit slip for verification and for our record.

Contact: Ronald Pornobi, MBA Business Development Officer

Globe: 0917-544-77-17 Smart: 0918-946-46-23 Sun: 0922-811-18-17

ibonropr@gmail.com ibonrop@ymail.com

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