Formulir Pendaftaran (silakan lengkapi formulir) --- Enrollment Form (please complete the form)

Pilih kursus dari menu dropdown di bawah ini - (Select course from below in dropdown menu)

HLTAID009-Berikan resusitasi kardiopulmoner (Provide cardiopulmonary resuscitation)

HLTAID011-Berikan Pertolongan Pertama (Provide First Aid)

HLTAID014-Pertolongan Pertama Tingkat Lanjut (Advanced First Aid)

Pilih Kursus Pertolongan Pertama --- Select First Aid the Course HLTAID009-CPRHLTAID011-First AidHLTAID014-Advanced First Aid

Pilih Lokasi Perguruan Tinggi atau Universitas --- Select the College or University Location Muhammadiyah Mataram (UMMAT)UIN Mataram Kampus 2Universitas BIMA International MFHUniversitas Muhammadiyah Palembang (UMPAL)

Pilih Ubin --- Select Tile Dr.Mr.Mrs.MissOther

Nama Anda --- Your Name Tanggal lahir --- Date of Birth Pilih Jenis Kelamin (wajib) --- Select Gender (required) MF Alamat Lengkap --- Complete Address Telephone Seluler --- Mobile Email Anda --- Your email Where did you hear about VCTD? (Please tick ONE box) FacebookTwitterWebsiteReferred FavorablyWorkplaceOther

Declarations and Consents (Mandatory)

Please read each statement carefully and confirm before submitting your enrolment.

I confirm that I have read and understood the course information and training requirements prior to enrolment. I acknowledge that I have read and understood the VCTD Policy page, including Fees and Refunds, Enrolment Conditions, Complaints and Appeals, and Privacy information. I understand that assessment is conducted in accordance with unit requirements and that certification is issued only after successful completion, trainer assessment, and administrative approval. I declare that the information provided in this enrolment form is true and correct to the best of my knowledge. I consent to the collection, use, and disclosure of my personal information in accordance with the Privacy Policy published on the VCTD Policy page.

Silakan Lampirkan Foto ID --- Please Attach Photo ID

Nama Anda --- Your Name (required)