• APPLICATION FOR REGISTRATION

  • APPLICATION FOR:

    Courses: *
    Packages: *

  • I AM SUBMITTING THIS APPLICATION FOR THE REGISTRATION/EVALUATION :

    FACILITY > UCP THAILAND

    LOCATION > BANGKOK - THAILAND

  • COURSE DATE APPLYING FOR *

    Is this your first time applying with UCP THAILAND? what training program did you take? Date of course taken

  • Personal Information

  • PRIVACY AND AFFIRMATION STATEMENT: I hereby affirm and declare that the provided information on this application is true and correct and that any fraudulent information stated herein may be considered a sufficient cause for rejection or denial of this information. All information contained in this application is to be used solely for the purpose of UCP THAILAND's requirements for applicants to disclose particular information and is to be used solely for registration purposes only; not to be released for any other purpose to third party such as individuals or other agencies without prior written approval from the applicant.

    APPLICANT SIGNATURE: * DATE:*

  • FOR UCP THAILAND USE

  • For Registration, payment should be made to UCP Group and submission of application should be completed before start of class. Please include account number for local students and copy of payment slip.

    DATE: Payment Received: Receipt No. :

    UCP THAILAND VERIFIED (Signature & Company Stamp)

  • Indemnity and Declaration

    Kindly answer the questions stated below as truthful to your knowledge.

  • 1) Are you suffering from any medical condition (hypertension, diabetes, heart condition) * If Yes (Please specify)
    2) Are you currently having any injuries which might aggravate due to strenous activities? *If Yes (Please specify)
    3) Have you been diagnosed to have any state of mental disorder? * If Yes (Please Specify)
    4) Are you currently in the process of any criminal justice? * If Yes (Please specify)
    5) Are you involved in any unlawful organizations or groups which will post a threat to national security? *

  • I hereby agree that measures are taken to ensure my safety. UCP THAILAND will not be responsible for any injuries or fatality occurred as a result of my negligience or any underlying medical conditions that I did not declare.

    *