Intake: Training Date:

(Fax to 03 – 7982 9811 or email: mbam14@mbam.org.my/mbam13@mbam.org.my)

Participant Details
Name :

NRIC : Gender : Male / Female Nationality :

Contact No. : Designation : Green Card Expiry Date :

Email : JKKP Reg No. (If Any) :

Academic Qualifications
Name of Secondary School / College/ University Highest Qualification Obtained

Employment and Working Experience

Current Employer Name of Company : Date of Employment :

Position :

Previous Name of Company : Date of Employment :

Employment
Position :

SPONSOR:  Self-Sponsor  Company

Company Details (Please fill in if company is selected)

Name of Company :

Address : Signature & Company Stamp:

Contact Person : Email :

Telephone No. : Fax :

Payment Details
Course Fee (All fees are inclusive of 6% Service Tax)
MBAM Member  RM 900.00
Non-MBAM Member  RM 1000.00

Payment Method
Online Transfer Date : ____________________ Time : ___________________

Cash Deposit Date : ____________________ Time : ___________________

Cheque Bank-In Date : ____________________ Time : ___________________

All payment should be made payable to:
MBAM Training Services Sdn Bhd Maybank Account No : 514-114-435-808
Due to the limited seats available, acceptance is based on first-come-first-serve basis. MBAM reserves the right to cancel or postpone any scheduled training.
Confirmation of class will be notified at least 7 days in advance from the date of scheduled date. Upon issuance of confirmation note, no cancellation request will be
entertained. However, a substitute participant is welcome without additional charges. Please extend a copy of your Bank-in slip to MBAM Secretariat as a proof of
payment. Advance payment is required for guaranteed participation.