Platinum Application

Is this your first Platinum registration?(Required)

Participant Information

Profile Photo(Required)

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

Please upload your profile photo here.

Title(Required)

Please specify your current title.

Full Name(Required)

Please enter your full name based on your I/C.

Identity Card No.(Required)

Please enter your identity card number.

Gender(Required)

Please select your gender.

Religion(Required)

Please state your belief / religion.

Race(Required)

Please specify your race.

Citizenship(Required)

Please state your citizenship. If you're a non-citizen, please specify.

Communication Information

Phone No.(Required)

Please enter your phone number.

E-mail(Required)

Please enter your valid e-mail address.

Facebook Name(Required)

Please enter your facebook name based on your facebook profile.

Education Information

Current Education Level(Required)

Please state your level in education.

Education Field(Required)

Please state your field of education.

Educational Institute(Required)

Please state your educational institue. If others, please specify.

Occupation(Required)

Please state your educational institue. If others, please specify.

Study Sponsorship(Required)

Please state your educational institue. If others, please specify.

Program Information

How did you know about us?(Required)

Please select one of the ways you discovered about DrRoket.

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

Please tell us more about the other way you know about us.,

Ala Carte(Required)

Please specify the type of ala carte you are interested.

Ala Carte - Technical Classes(Required)

Please specify the Ala Carte - Technical Classes you are interested.

Ala Carte - Others(Required)

Please specify the Ala Carte - Others you are interested.

Batch(Required)

Please select which batch you are in.

Batch - Others(Required)

Please specify for the other unstated batch you are in.

Platinum Members Only

Do you have a Referral?(Required)

Please state whether there's someone introduced you about the platinum program.

Referral - Name(Required)

Please enter the referral's name.

Referral - Batch(Required)

Please state the referral's batch.

Member's Confirmation

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)

Proof of Transaction

Max. file size: 100 MB.

Please upload your photo for proof of your successful transaction.

DR Platinum Application

Participant Information

Communication Information

Education Information

Program Information

Platinum Members Only

Member's Confirmation

Payment Confirmation

MAKLUMAT UNTUK DIHUBUNGI

Ada Soalan? Hantar Di Sini