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Registration

ROAD SAFETY REVIEWER ACCREDITATION COURSE 26 to 29 September 2011 LTA Academy Blk 5A Level 1, No. 1 Hampshire Road, Singapore 219428. Course Fees. (SGD) S$2,500 + S$175 (7% Goods & Services Tax, GST) Note: GST is applicable to Singapore based participants only.

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Registration

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  1. ROAD SAFETY REVIEWER ACCREDITATION COURSE 26 to 29 September 2011 LTA Academy Blk 5A Level 1, No. 1 Hampshire Road, Singapore 219428 Course Fees (SGD) S$2,500 + S$175 (7% Goods & Services Tax, GST) Note: GST is applicable to Singapore based participants only Closing Date for Registration 9 September 2011 Registration Fax or email the completed registration forms to : +65 6396 1585 or LTAAcademy@lta.gov.sg. Particulars and Experience of Participants I agree that LTA Academy shall not be liable for any loss, damages and/or injury, including loss of life, which I may suffer arising out of or in connection with this Course, whether the loss, damage and/or injury was suffered on any of Land Transport Authority’s premises or at any other venue(s) in connection with this Course. I have read and fully understood all the terms, conditions, requirements and enrolment criteria for this Course. I understand and accept that Land Transport Authority may reject my application for enrolment for this Course at its sole discretion without giving any reason. Signature of Applicant / Date Important: Please proceed to fill in next page for payment purpose.

  2. LTA Academy - Course Registration Form • All payment should made in Singapore dollars • Payments by S$ bank draft or cheque should be made payable to: “Land Transport Authority”, please quote course title at the back of cheque. • Payment by telegraphic transfer, in S$, must be made to: • GST registration number : M4-0006529-2 Note: * means input is required.

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