ACL/CISSP/01701/REGFORM Page 1 of 2 April 2017, CISSP Kuala Lumpur

CISSP® TRAINING SEMINAR

REGISTRATION FORM Please fill in the form clearly in CAPITAL LETTERS. All pages of this form must be completed. Incomplete forms will be returned.

PERSONAL INFORMATION Full Name as per IC / Passport (This name will appear on the certificate):

q Mr. q Mrs.

q Miss q Ms.

Home Address:

City/Town:

State: Post Code: Country:

Mobile Phone No.:

Personal Email:

EMPLOYER DETAILS Organisation Name:

Title/Position: Sector (Specify Private / Public Sector):

Business Address:

City/Town:

State: Business Email:

Post Code: Country:

Business Phone No.: Business Fax No:

COURSE INFORMATION

Course Date: 17 – 21 April 2017

Location: Cyberjaya, Malaysia

Course Title: CISSP® CBK® Training

FEES

Training Fees: MYR 6,400 (exam fees not included) • Early Bird Discount Available (registration & payment received on or before 20 March 2017) • Group Discount Available (2 or more candidates from the same organisation) Please contact us for more information.

Exam Fees: USD 599

ACL/CISSP/01701/REGFORM Page 2 of 2 April 2017, CISSP Kuala Lumpur

MODE OF PAYMENT PAYMENT IS DUE AT THE TIME OF REGISTRATION Payment must be made in MYR by cheque, money order/bank draft or bank transfer to AKATI CONSULTING (M) SDN. BHD. Credit card payment will be processed by (ISC)2 in USD$. Please tick (Ö) the desired payment mode as follows.

Cheque (Fill in Cheque number):

Credit Card Type of Credit Card Credit Card No: Expiration Date (MM/YY)

VISA

MasterCard

American Express

Billing Address:

Money Order/Bank Draft (Fill in document reference number):

Bank Transfer Bank Name: CIMB BANK BERHAD

Account Name: AKATI Consulting (M) Sdn Bhd

Bank A/C No: 80-0710691-3 SWIFT code: CIBBMYKL

Bank’s Address: KLIA Sepang, Lot MTBD, 14(B), Departure Level, Main Terminal Building, 64000 KLIA Sepang, Selangor, Malaysia

AGREEMENT AND DISCLAIMERS Please read and understand the following disclaimer. Upon signing and sending in this registration form, it is understood that you have understood, acknowledged and agreed upon the following terms of service: Fees must be paid before the start of the training. Registration is accepted on a "first come - first served" basis based on receipt of payment in full. If (ISC)² cancels a seminar: (ISC)² or AKATI Consulting (M) Sdn. Bhd. reserves the right to cancel any seminar 15 days in advance if attendance is insufficient. In this case, (ISC)² and AKATI Consulting (M) Sdn. Bhd. liability shall be limited to full refund of fees paid. If the candidate chooses to reschedule exam or seminar instead of receiving refund, the candidate will receive a refundable voucher valid for one year from date of issuance to reschedule. The burden is on the candidate to track when the one-year period expires, as (ISC)² and AKATI Consulting (M) Sdn. Bhd. will not notify the candidate. If Candidate cancels a seminar: All cancellation or rescheduling requests received in writing with 22 days’ notice or more will incur a USD100/EUR100/GBP70* cancellation fee or rescheduling fee (Refund = Amount Paid, Less USD100/EUR100/GBP70). Written cancellation or rescheduling requests received five calendar days or more prior to the training will be given credit towards attendance at a subsequent training only (no refund) and will incur an additional USD100/EUR100/GBP70 rescheduling fee. Cancellations received with less than five calendar days’ notice and "no-shows" will not be given a refund, nor credit toward a later program (unless there is a documented medical emergency). Rescheduling or canceling both a review seminar and an exam will incur two USD100/EUR100/GBP70 fees for a total of USD200/EUR200/GBP140. For registered candidates yet to make full payment: Cancellations received with less than 10 business days’ notice and “no-shows” will be subjected to 100% of the training fees. *Please note - the fees you pay will depend on the location of the event. Local taxes may be charged in addition, where applicable. Note: (ISC)² will not accept third party payments or applications for any (ISC)² seminar applicant unless the third party is a government agency, the applicant's employer, or is otherwise authorized by (ISC)² prior to the application being submitted. I understand that the material and content of the CBK Review Seminar are proprietary to (ISC)² and protected by appropriate intellectual property laws. (ISC)² has incurred great expense to develop, produce, and present the material and content of the CBK Review Seminar. The material and contents may not be copied, transferred, exchanged, sold, disclosed, or otherwise disseminated to anyone outside the seminar, and may only be used by me for personal study. Any breach of this Agreement will be grounds for revocation of the certification designation, if awarded, and appropriate legal action.

Applicant Signature (compulsory):

Date (compulsory):

Please mail / email this completed Registration Form to: Mr. Alfred Tan – alfred@akati.com (Mobile: +6017.696.2398) Ms. YubaShree – yuba@akati.com (Mobile: +6013.692.5953) Ms. Joanna Woon – Joanna@akati.com (Mobile: +6019.267.2982) AKATI Consulting (M) Sdn. Bhd. Suite 1-15, Block 4807, CBD Perdana 2, Jalan Perdana 63000 Cyberjaya, Malaysia Office contact #1: +603.8688.4778 | Office contact #2: +603.8688.4776 Website: www.akati.com | Email: hello@akati.com

(ISC)²® Candidate Services in Hong Kong: E: pvictor@isc2.org T: +852.2850.6951