Workshop Registration Form

Workshop Registration Form
Part A: Participant's Particulars

Please fill in in your personal details. Those fields marked with red "*" are mandatory fields.
Seminar/Workshop Title*
Date of Event
Cost of Event
Discount Percentage
Today's Date

MonthDayYear
Full Name*

PrefixFirst NameLast Name
E-mail*
Phone Number*

Country CodeArea CodePhone Number
Type of Sponsor*

SelfCompany
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Name
Contact Person (HR/Finance)
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Designation*
Department
Dietary Requirements (You may select more than one option)*

Non-VegetarianVegetarianHalal
Please update me via emails and/or telephone with information of future events including complimentary sessions unless I select to refuse these below.

I do not wish to receive information by emailI do not wish to receive information by telephone
Part B: Payment Details

Please provide information for mode of payment
Promo Code
Insert your promo code (if any)
Mode of Payment*

ChequePayPal / Credit Card
Cheque Number
Cheque Number eg DBS-123456
Final Total (Cheque)
Final Total (PayPal)
Final Cost Workshop

prevnext( X )
SGDPayment for Workshop
Please make cheque in favour of "Insight Academy Pte Ltd". Please also write your name, contact number and title of the workshop at the back of the cheque. You can send the cheque to the following address:

Insight Academy Pte Ltd

2 Stratton Place

Singapore 806815
You have selected to pay via your designated PayPal account or if do not have a PayPal account you have the option to pay by credit card (MasterCard or Visa etc). On submission of this form you will be directed to PayPal payment system page to proceeed with the payment for both options.
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Workshop Registration Form

Part A: Participant's Particulars

Part B: Payment Details