XpRienz Lifestyle Course Registration Form
SSG Registered Training Provider XpRienz Pte Ltd - UEN 200409177Z
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Choose your course *
Full Name *
Enter Full Name as in your Identification Document
NRIC no. *
Enter only the last 4 digits/alphabets  (e.g. SXXXX123A)
Mobile contact number *
Email address *
Date of birth *
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Gender *
Residential status *
Race *
Postal code *
Highest Education Level *
Employment Status *
DECLARATION/ ACCEPTANCE                                                                                                                                                           1. I hereby declare that the above personal information given is true and correct.                                                       2. I hereby consent that Xprienz Pte Ltd is allowed to use the information provided above for all matters related to the course(s) I have attended.                                                                                                              3. I hereby acknowledge that the training provider will not be held liable to resubmit the result should there is error found on the Name and/or identification number after the course has ended.                                                                                                                                                                                                         4.I hereby consent to XpRienz's use of any images or videos taken before, during or after the course.                                                                                                                                                                                   *
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