REGISTRATION

FORM Confined Space (Utama)

Public Training Program :

Date : 4 - 8 Februari 2020

Time : 08:00 am – 17:00

Company Name :
Venue : PT. HM Sampoerna -
Karawang Plan Address :

Contact Person : Phone/ HP :

Fax Number :
e-Mail Address :

Name of Participants/ Delegates :

1. 4.
2. 5.
3. 6.

SURABAYA – INDONESIA
CONFIRMATION OF REGISTRATION
Signed by :
INVESTMENT : (Name & Position)

IDR 5.000.000,-/participant
Public Training

NOT Include : Accommodation & Transportation

Please Confirm REGISTRATION

Cash Payment
Payment by transfer to :
PT. MITRA KUALITAS UTAMA, For more information regarding this public
BCA Oakwood Mega Kuningan, Jakarta training, just email us at:
No acc. 501.505.3639 marketing.sby@gosafeacademy.com
or
Note : Cancellation fee within one week before
Call : Dimas
the training commencement is 50% from
at (031) 8296996 or 0811 3292 488
investment

Graha Asri Blok K – 12B jl. Ngagel 179 – 183 Surabaya, 60246
www.PremysisConsulting.com | training.sby@premysisconsulting.com