Association Connecting Electronics Industries S.E. Asia Representative Office IPC - Association Connecting Electronics Industries Tel: +84 984311599 E-mail: HenryTon@ipc.org Website: COURSE REGISTRATION FORM Course Fee / Person ✓ Course Name Non-Member USD 1,275 IPC-A-620 CIS (Certified IPC Application Specialist) IPC Member: USD 775 IPC Member: USD 2,275 IPC-A-620 CIT (Certified IPC Trainer) Non-member: USD 2,835 Course Dates From To Course Venue NAME of the COMPANY / ORGANIZATION / INDIVIDUALS Address Contact Person Contact Phone #s Contact E-mail I.D. PARTICIPANT'S PROFILE NAME (in block letters) S/N Email Job Title Experience Contact phone/mobile 1 2 3 4 5 6 7 8 The above participants from our company may be registered for the specified course The proforma Invoice for the THIS FORM IS REQUIRED TO BE SIGNED BY THE course fee to be sent to the AUTHORISED SIGNATORY OF YOUR ORGANIZATION. IN address >> THE ABSENCE OF YOUR P.O., THIS FORM WILL BE TREATED (provide the correct postal address AS A P.O. AND ORDER CANCELLATION CHARGES WILL with email, fax/phone no. & contact APPLY AS MENTIONED IN OUR PROFORMA INVOICE. person) Place: Authorized Date: Signatory For use by IPC S.E. ASIA
Association Connecting Electronics Industries S.E. Asia Representative Office IPC - Association Connecting Electronics Industries Tel: +84 984311599 E-mail: HenryTon@ipc.org Website: COURSE REGISTRATION FORM Course Name Course Fee / Person ✓ IPC-A-620 CIS (Certified IPC Application Specialist) Non-Member USD 1,275 IPC Member: USD 775 IPC-A-620 CIT (Certified IPC Trainer) IPC Member: USD 2,275 Non-member: USD 2,835 Course Dates From To Course Venue NAME of the COMPANY / ORGANIZATION / INDIVIDUALS Address Contact Person Contact Phone #s Contact E-mail I.D. PARTICIPANT'S PROFILE S/N NAME (in block letters) Contact phone/mobile Email Job Title Experience 1 2 3 4 5 6 7 8 The above participants from our company may be registered for the specified course The proforma Invoice for the course fee to be sent to the address >> (provide the correct postal address with email, fax/phone no. & contact person) THIS FORM IS REQUIRED TO BE SIGNED BY THE AUTHORISED SIGNATORY OF YOUR ORGANIZATION. IN THE ABSENCE OF YOUR P.O., THIS FORM WILL BE TREATED AS A P.O. AND ORDER CANCELLATION CHARGES WILL APPLY AS MENTIONED IN OUR PROFORMA INVOICE. Place: Authorized Signatory Date: For use by IPC S.E. ASIA
Public_IPC-A-620-registration-form.docx