INTACTT GROUP LTD
#163 Eastern Main Road, Tunapuna, Trinidad, W.I.
Ph: 868-289-0486
Email: Web:www.intactt.com
PROJECT MANAGEMENT PROGRAMMES
REGISTRATION FORM (Early Bird)
JUNE 2015 Exam
Please complete in BLOCK LETTERS
1. Participant information Title (Mr/Mrs/Ms/Miss/Dr) ……………………… Sex M F
Surname/Family Name ……………...…………………………………………………………………………..
Other Names …………………………………………………………………………………………………………..
2. Contact information (please ensure you provide email details as well as phone.)
Address ……………………………………………………………………………………………………………………………….
…………………………………………………..…… Country ………………………………………………..…
Phone (home/work) ……………………….…………. Cell …………………………………..
E-mail ……………………………………………………………………………………………………….
3. Employment information
Name of company/organization ……………………………………………………………….………………………………..
Your current position/job title ……………………………………………………………………………………………………
4. PAYMENT DETAILS
Please tick the course you are subscribing for:
¨ CAPM ONLINE $2,150 ¨ PMP ONLINE TT$3,150 ¨ MS PROJECTS ONLINE $2,400
¨ CAPM CLASSROOM $4,250 ¨ PMP CLASSROOM $6,150 ¨ PRINCE2 FOUNDATION $2,900
¨ CAPM Practice test $295 ¨ PMP Practice test $395 ¨ PRINCE2 PRACTITIONER $3,200
DURATION OF ONLINE COURSE: ______
Additional Late fees of $250 apply when deadlines are missed
Fees are payable in $TTD using one of the following methods. Please indicate which method you will use: þ
a) By cheque or bank draft made payable to INTACTT GROUP LTD
b) By cash at our office located at #163 Eastern Main Road, Tunapuna
c) Via Direct deposit to our account Intactt Group Ltd account # 1 000 000 1079 781 at any RBC Royal Bank Branch
d) For payments in US dollars or wire transfers please inquire
Please print your name in full on bank deposit forms and email or attach a copy of your bank’s payment with your Application Form as proof of payment.
CONDITIONS OF REGISTRATION
§ Persons will be registered on a “first come, first served” basis.
§ Registration is confirmed upon receipt of payment.
§ All sales are final
Registration Authorization
I agree to the above conditions of registration and authorize the applicant’s registration.
Name in block letters
Title (Mr/Mrs/Ms/Miss/Dr) ……………………………………………………………………………………………………
Signature …………………………………………………………………………………………………………………………….
NOTES FOR OFFICIAL USE ONLY