* 1. Full Name

* 2. E-mail Address

* 3. Personal Cell Number

* 4. Organization & Job Title

* 5. Do you have any physical injury(ies) that may prevent you from actively participating in this type of training, e.g. seizures, wrist/elbow fractures, knee/ankle injuries, etc.?

* 6. Do you currently/plan to work in a hostile environment? If yes, please briefly state as to what your job function will be.

* 7. How many people will be registering for this training? There is a 10% discount to groups of three (03) or more

* 8. Please select the training cycle you are interested in:

* 9. I understand that the Hostile Environment Awareness & First Aid Training (HEFAT-2) is a two-day / 16-hour program and certificate is issued to only those participants that fulfill the entire time commitment and instructor requirements. HEFAT-2 costs Rs. 30,000 (non-refundable) per person, due no later than the date communicated to me by the training firm, and does not include any lodging/travel.

* 10. Please select a payment option:

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