Use resources and initiative to build a great career. • Rediscover meaning and
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How to Create Your Ultimate Job and Make an Extraordinary Contribution!
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PROGRAM
GREAT WORK GREAT CAREER
REGISTRATION
By FranklinCovey Malaysia Facilitator How Did You Know About This Program? (You may tick more than one )
PROGRAM DETAILS
COMPANY / ORGANIZATION DETAILS
DATE August 21-22, 2013
COMPANY / ORGANIZATION NAME:
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) E-mail Blast
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ADDRESS:
TIME 9:00 am – 5:00 pm VENUE Leadership Resources Training Centre Solaris Dutamas, Kuala Lumpur
NAME OF CONTACT PERSON: MR/MS TEL:
YOUR INVESTMENT RM 1,500 per participant
EMAIL:
FAX:
PARTICIPANT DETAILS
RM 1,300 per participant Group Rate for groups of 5 or more from the same organization
1 MR/MS:
MOBILE NO:
EMAIL:
DESIGNATION:
2 MR/MS:
MOBILE NO:
EMAIL: CLAIMS & GRANT ELIGIBILITY
DESIGNATION:
3 MR/MS:
Kindly tick to indicate your claim/grant eligibility (applicable to Malaysian participants only) : [ ] HRDF CLAIMS: SBL Terms & Conditions Apply
MOBILE NO:
EMAIL:
DESIGNATION:
4 MR/MS:
MOBILE NO:
EMAIL:
DESIGNATION:
5 MR/MS:
ENQUIRIES & REGISTRATION TEL 603.6205 5550 FAX 603.6205 5551 EMAIL
[email protected] WEB www.leadershipresources.my
TERMS & CONDITIONS
MOBILE NO:
EMAIL:
DESIGNATION:
TOTAL NUMBER OF PARTICIPANTS:
TOTAL AMOUNT PAYABLE: RM
APPROVING MANAGER'S NAME:
DESIGNATION:
SIGNATURE & COMPANY STAMP:
DATE:
1. Registrations will only be confirmed upon receipt of payment. 2. Registrations made without payment are subject to our cancellation without prior notice. Payments are to be made at least ONE month in advance to ensure your booking is confirmed. 3. Please make cheques, marked A/C Payee Only, payable to: Leadership Resources (Malaysia) Sdn Bhd.
PAYMENT DETAILS DIRECT BANK-IN:
BANKER: HSBC BANK MALAYSIA BHD PAYABLE TO: LEADERSHIP RESOURCES (M) SDN BHD ACCOUNT NO: 302-558879-001
CHEQUE/BANK DRAFT NO:
4. There will be no refund for cancellationby participants less than 30 days before the program date. We will however, on case-bycase basis, allow replacements to be made, upon communications of full details of the new participant. 5. The organizer reserves the right to cancel the program due to unforeseen circumstances. In such event, the fee would be refunded in full.
CREDIT CARD DETIALS:
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] AMERICAN EXPRESS
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] VISA
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) Please provide us an Invoice for payment purposes
] MASTERCARD EXPIRY DATE (MM/YY):
CARD NO:
AMEX ID NO:
CARDHOLDER NAME:
SECURITY CODE: *3 digits after Card No. at back of card
SIGNATURE (FOR CREDIT CARD PAYMENT):
DATE:
LEADERSHIP RESOURCES (MALAYSIA) SDN BHD
( 273497-D)
D4-1-8, Solaris Dutamas, No.1, Jalan Dutamas 1, 50480, Wilayah Persekutuan, Malaysia
THE TRAINING, COACHING AND IMPLEMENTATION COMPANY THAT SPECIALIZES IN ORGANIZATIONAL LEADERSHIP AND INDIVIDUAL EFFECTIVENESS