HIGH PRESSURE WATER JET (HPWJ) HIGH PRESSURE WATER JET (HPWJ) Date Course (Tarikh Kursus) * Melaka 18/1/21 - 20/1/21 Melaka 24/2/21 - 26/2/21 Melaka 19/3/21 - 21/3/21 Melaka 16/4/21 - 18/4/21 Melaka 26/5/21 - 28/5/21 Melaka 29/6/21 - 31/6/21 Paka 10/1/21 - 12/1/21 Paka 8/2/21 - 10/2/21 Paka 9/3/21 - 11/3/21 Paka 6/4/21 - 8/4/21 Paka 11/5/21 - 13/5/21 Paka 6/6/21 - 8/6/21 Participant Name (Nama Peserta) * IC Number (No. Kad Pengenalan) * Email * Home Address (Alamat Rumah) * Poscode (Poskod) * State (Negeri) * Melaka Kuala Lumpur Johor Negeri Sembilan Terengganu Pahang Perlis Perak Pulau Penang Kedah Kelantan Selangor Sabah Sarawak Home Tel. Number (No. Tel. Rumah) Handphone Number (No. Tel. Bimbit) * Physical Health Condition (Tahap Kesihatan Fizikal) Physical Body (Fizikal Badan) Heart (Jantung) Lung (Paru-paru) Eyes (Mata) No (Tiada) Source of Information about Course (Sumber mendapat maklumat mengenai kursus) * Acquaintance (Kenalan) Facebook Website (Laman Web) Media (Media Cetak) If you are human, leave this field blank. Submit