Course Name

Number of Participant

Name of Registrant

Fill the information below, if you are the administrator of your company who makes the registration. If you are registering for yourself, please ignore it.

First Name

Last Name

Email of Registrant

Mobile Phone No.

Job Title

Name of Company

Name of Participant

First Name

Last Name

Nick Name

Mobile Phone No.

Job Title

Participant 2 and more

Please fill in the details of other participants below. Please include: Full name, Nick name, Email, HP, and Job Title.

Total Investment

Please do not leave this blank. Put 0 if you get the course for free.

Payment

For transfer, please make the payment to PT Imago Global Sukses, BCA Panglima Polim a/c 566 04 009 09

Remarks:

· Registration is only valid after we received the payment (please attached/fax the transfer slip to Imago). Payment (either via bank transfer or cash) should be made at least 2 (two) days before the course day.

· Participant should come at 30 minutes before the program is started for re-registration procedure.

· Imago has the right to re-schedule or cancel a program if total participant is below the minimum. We will re-fund (full amount) any payment made.

· BOOKING IS TRANSFERABLE – CANCELLATION IS NOT ACCEPTED