Professional Documents
Culture Documents
To register for our public training, simply complete this form. Please use a
separate copy for each person attending.
This form can be filled out electronically in any PDF reader or it can be printed
and filled out by hand.
Registration Details
Course Title:
Name in Full:
Transportation ***: o Samson Tiara Transport o Personal Transport o Airport Pickup / Special Arrangement
Billing Details
Company Name:
Country:
Contact Person:
Tel: Fax:
Email:
Things to note
* Delegate mobile phone number is required for contact incase of transportation issues or late arrival.
** The full cost of accommodation will be billed back to the delegate or their representative.
*** If special transport / airport pick up is required please inform administration when booking. Additional charges will
be incurred. Samson Tiara provided transport applies only to training in Cilegon.
**** Payment by credit card incurs a 3% surcharge as levied by the bank.
Standard transportation is provided only between designated pickup and drop off points and is only for training
participants.
Please consider the environment before printing. This form can be filled out electronically and submitted by email.
PM-FM-07-04A / Rev. 9