<form action=”process_registration.php” method=”POST”>
<h2>PMP Safety – Course Registration</h2>
<p>We are committed to protecting your privacy and ensuring the security of your personal information.
We kindly request only the necessary details marked with an asterisk (*) to comply with our requirements.
Please rest assured that your information will not be shared with any third parties in a way that could impact your privacy or security.</p>
<p>Thank you for your cooperation.</p>
<h3>Personal Information</h3>
<label for=”name”>Full Name*:</label>
<input type=”text” id=”name” name=”name” required>
<label for=”lastname”>Last Name*:</label>
<input type=”text” id=”lastname” name=”lastname” required>
<label for=”dob”>Date of Birth*:</label>
<input type=”date” id=”dob” name=”dob” required>
<label for=”email”>Email Address*:</label>
<input type=”email” id=”email” name=”email” required>
<label for=”contact”>Contact Number*:</label>
<input type=”text” id=”contact” name=”contact” required>
<label for=”gender”>Gender*:</label>
<select id=”gender” name=”gender” required>
<option value=”male”>Male</option>
<option value=”female”>Female</option>
<option value=”other”>Other</option>
</select>
<label for=”country”>Country*:</label>
<select id=”country” name=”country” required>
<option value=”Australia”>Australia</option>
<option value=”United States”>United States</option>
<option value=”United Kingdom”>United Kingdom</option>
<option value=”Canada”>Canada</option>
<option value=”India”>India</option>
<option value=”Other”>Other</option>
</select>
<label for=”english”>Level of English Proficiency*:</label>
<select id=”english” name=”english” required>
<option value=”basic”>Basic</option>
<option value=”intermediate”>Intermediate</option>
<option value=”advanced”>Advanced</option>
<option value=”fluent”>Fluent</option>
</select>
<h3>Course Selection</h3>
<label for=”course”>Which course are you applying for?*:</label>
<select id=”course” name=”course” required>
<option value=”IOSH-Managing safely”>IOSH-Managing safely</option>
<option value=”NEBOSH General Certificate”>NEBOSH General Certificate</option>
<option value=”NEBOSH Certificate in Oil & Gas”>NEBOSH Certificate in Oil & Gas</option>
<option value=”Effective Leadership in OHS”>Effective Leadership in OHS</option>
<option value=”NEBOSH Risk Assessment”>NEBOSH Risk Assessment</option>
<option value=”NEBOSH Diploma”>NEBOSH Diploma</option>
<option value=”NEBOSH Certificate in Process Safety Management”>NEBOSH Certificate in Process Safety Management (PSM)</option>
<option value=”Tripod Beta Incident Investigation”>Tripod Beta Incident Investigation</option>
<option value=”Safety in Pre-Commissioning”>Safety in Pre-Commissioning</option>
<option value=”BowTie Barrier Analysis”>BowTie Barrier Analysis</option>
<option value=”Hazard Identification & Risk Assessment”>Hazard Identification & Risk Assessment</option>
<option value=”ICAM Incident Investigation”>ICAM Incident Investigation</option>
<option value=”Other”>Other…</option>
</select>
<h3>Class Type Preference</h3>
<label>Which type of class do you want to attend?*:</label>
<input type=”radio” name=”class_type” value=”E-learning” required> E-learning (with access to the tutor)
<input type=”radio” name=”class_type” value=”Online” required> Online (Through Adobe Connect or Microsoft Teams)
<input type=”radio” name=”class_type” value=”On-campus” required> On-campus (Class-based in PMP office)
<h3>Additional Information</h3>
<label for=”company”>Company Name:</label>
<input type=”text” id=”company” name=”company”>
<label for=”academic”>Academic Background*:</label>
<select id=”academic” name=”academic” required>
<option value=”High School”>High School</option>
<option value=”Diploma”>Diploma</option>
<option value=”Bachelor’s Degree”>Bachelor’s Degree</option>
<option value=”Master’s Degree”>Master’s Degree</option>
<option value=”PhD”>PhD</option>
</select>
<label for=”experience”>Relevant Experience (Years):</label>
<input type=”number” id=”experience” name=”experience”>
<label>Do you need additional support?*:</label>
<input type=”checkbox” name=”support[]” value=”mentoring”> Mentoring
<input type=”checkbox” name=”support[]” value=”consulting”> Consulting
<label>Do you have any disabilities and require support to maximize learning?*:</label>
<input type=”checkbox” name=”disability[]” value=”visual”> Visual Impairment
<input type=”checkbox” name=”disability[]” value=”hearing”> Hearing Impairment
<input type=”checkbox” name=”disability[]” value=”mobility”> Mobility Issues
<input type=”checkbox” name=”disability[]” value=”other”> Other…
<label for=”additional_info”>Additional Information:</label>
<textarea id=”additional_info” name=”additional_info”></textarea>
<h3>Agreement & Confirmation</h3>
<p>By submitting this form, I confirm that I have been provided with all necessary information and that I am ready to sign this basic agreement. I understand that this agreement does not bring any commitment at this stage.</p>
<label for=”signature”>Electronic Signature*:</label>
<input type=”text” id=”signature” name=”signature” required>
<br><br>
<input type=”submit” value=”Register”>
</form>