1. REGISTRATION APPLICATION
BRAIN TECH ACADEMY: HIGH IMPACT LEARNING & REMEMBERING PROGRAMME
BRAIN TECH ACADEMY PLT 202-B-3, JALAN BURMA 10350 PENANG. braintechacademyplt@gmail.com
For enquiries please call : 012-2819331 (Pri) 017-8912331 (Vairavan)
017-8962331 (Ratna) 012-4921442 (Ravi) APPLICANT INFORMATION
PARTICIPANT’S NAME:
DATE OF BIRTH:
NRIC:
PHONE:
CURRENT ADDRESS:
CITY:
STATE:
POSTAL CODE:
GENDER :MALE/FEMALE
COUNTRY :
EMAIL:
SCHOOL/COLLEGE/UNIVERSITY/OTHERS : CONTACT PERSON’S DETAILS
NAME:
ADDRESS:
RELATIONSHIP :
PHONE:
EMAIL:
FAX:
CITY:
STATE:
POSTAL CODE: REGISTRATION FEES
RM1900.00 PER PAX (10% DISCOUNT OFFERED FOR SIBLINGS)
I ________________________________ NRIC __________________
HEREBY ENCLOSE :
CASH BY HAND FOR THE AMOUNT OF RM________________
CASH BANK IN FOR THE AMOUNT OF RM________________
CHEQUE NO __________________
NOTE : ALL PAYMENT MADE PAYABLE TO BRAIN ACADEMY PLT ARE NON REFUNDABLE.
CASH & CHEQUE BANK INTO
BRAIN TECH ACADEMY PLT
CIMB BANK
ACCOUNT NO :
8007300713
TERMS & CONDITIONS
1. SUBSTITUTE OF PARTICIPANT ALLOWED, PROVIDED THE ORGANISER IS NOTIFIED IN WRITING OF THE NAME OF THE NEW
REPLACEMENT WITH FULL DETAILS.
2. TRANSFER OF REGISTRATION TO OTHER PROGRAMME IS NOT ALLOWED.
3. WE RESERVE THE RIGHTS TO CANCEL AND/OR POSTPONE THE PROGRAMME DUE TO UNFORSEEN CIRCUMSTANCES.
PRIVACY & DISCLAIMER STATEMENT
YOU ARE RECEIVING THIS FLYER BECAUSE YOU HAVE ATTENDED OUR EVENTS OR PART OF OUR BUSINESS CONTACTS DATA BASE.THE ORGANISER RESERVES THE RIGHTS TO USE THE ABOVE INFORMATION TO PROCESS YOUR REGISTRATION.THE ORGANISER WILL NOT DISCLOSE YOUR INFORMATION TO ANY THIRD PARTY UNLESS YOU HAVE CONSENTED TO SUCH DISCLOSURE OR WHERE WE ARE REQUIRED TO DO SO BY LAW.THE INFORMATION MAY BE USED TO CONTACT YOU FROM TIME TO TIME TO PROMOTE OR ANNOUNCE NEW PRODUCTS AND SERVICES OFFERED BY THE ORGANISER.
FOR MORE INFORMATION , PLEASE VISIT http://www.braintechacademymalaysia.com
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