Are you a new or existing learner?
What is the course you are interested in? *
Please enter the product number
Full Name: *
Your answer
Gender: *
ID Type: *
ID Number: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Nationality: *
Your answer
Race: *
Your answer
Contact Number: *
Your answer
E-mail: *
Your answer
Preferred contact method: *
Required
Highest Qualification: *
Your answer
Employment Status: *
If employed, please state your current company name:
Your answer
Your designation in your current company:
Your answer
Your Salary Income:
Your Preferred Payment Mode: *
Would you like to receive updates on our training courses?
If Yes, please select (one or more) your preferred mode of contact:
Tea Breaks / Meal Preferences (if any) *
For course withdrawal, a written notice must be submitted and received by AQulture 3 weeks before course commencement date. All requests will be subjected to approval. An administrative charge of $10.00 will be imposed for all approved withdrawals based on case by case basis. Strictly no refund (partial or full amount) of course fee for any withdrawal of courses 2 weeks before course commencement date. *
I confirm that all information given in this registration form is true and accurate, and I have not deliberately omitted any relevant fact. I understand any false or misleading declaration shall make me liable for disqualification, or if already admitted, for expulsion from the course without any refund of fees paid. I have read and affirmed the Terms and Conditions I agree to comply and abide by the decision of AQulture Pte Ltd concerning this application. *
Submit
Never submit passwords through Google Forms.
This form was created inside of AQULTURE. Report Abuse