Platinum Application - Dr Roket

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DR Platinum Application

Type of Registration(Required)

New

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Ala Carte

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Is this your first Platinum registration?(Required)

Participant Information

Profile Photo(Required)

Accepted file types: jpg, jpeg, png, Max. file size: 100 MB.

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Title(Required)

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Full Name(Required)

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Identity Card No.(Required)

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Gender(Required)

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Religion(Required)

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Race(Required)

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Citizenship(Required)

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Communication Information

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Phone No.(Required)

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E-mail(Required)

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Facebook Name(Required)

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Education Information

Current Education Level(Required)

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Education Field(Required)

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Educational Institute(Required)

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Occupation(Required)

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Study Sponsorship(Required)

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Program Information

How did you know about us?(Required)

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What is the other way you know about us?(Required)

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Program Interested(Required)

Platinum Professorship

Platinum Premier

Platinum Elite

Platinum Dr. Jr.

Ala Carte

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Ala Carte(Required)

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Ala Carte - Technical Classes(Required)

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Ala Carte - Others(Required)

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Batch(Required)

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Batch - Others(Required)

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Platinum Members Only

Do you have a Referral?(Required)

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Referral - Name(Required)

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Referral - Batch(Required)

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T-Shirt Size (Berkolar & Lengan Pendek Sahaja)(Required)

XS

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2XL

3XL

Member's Confirmation

Consent(Required)

I hereby confirm that the details I have filled on this application are true and valid.

Date of Application(Required)

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Payment Confirmation

Please proceed to your account transaction with the amount based on the Platinum level of your choice (DISCLAIMER:ALL PURCHASES ARE CONFIRMED & NON REFUNDABLE)

Payment Mode

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FPX - Referral

Direct Transfer / Payment

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Proof of Transaction

Max. file size: 100 MB.

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2M World Sdn Bhd
(1205503-D)

113A-2 Jalan Prima SG 4
Prima Sri Gombak,
Batu Caves, 68100
Selangor Darul Ehsan,
Malaysia.

Telefon:
+6018 248 6003 (NAZEEFA)
60 194588003 (AISYAH)
+60 183998003 (HIDAYAHCJ)

Emel: cs.2mworld@gmail.com

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Dr Roket - Guru Master PhD Strategist No. 1 Malaysia