WORKING AT HEIGHT (WAH) WORKING AT HEIGHT (WAH) Date Course (Tarikh Kursus) * Melaka 05/07/19 - 06/07/19 Melaka 28/08/19 - 29/08/19 Melaka 24/09/19 - 25/09/19 Melaka 14/10/19 - 15/10/19 Melaka 05/11/19 - 06/11/19 Melaka 16/12/19 - 17/12/19 Paka 20/08/19 - 21/08/19 Paka 18/11/19 - 19/11/19 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