License Interest Registration Form

 

Kindly complete the following and fax or mail to us at LST Protocol International Pte Ltd, 30 Raffles Place #23-00 Caltex House, Singapore 048622. Tel: (65) 6233 6832. Fax: (65) 6233 6257. Email:  percetiq@percyinstitute.com.

Web: www.thepercyinstitute.com

Upon receipt of your enquiry, we will be in touch with you for further discussion. All information will be kept strictly confidential.

 

1. Contact Information                                                                               

 

Name of Company/Individual: _______________________________________

Contact Person in Company: ________________Designation: ______________

Address: _________________________________________________________

City: ___________________________ Country: _________________________

Tel: _________________(H)_______________(O)________________(Mobile)

Fax No: __________________Email Address: ___________________________

Website URL: _____________________________________________________

 

2. Business Interest Information                                                                 

 

a) How did you hear about The Percy Institute of International Protocol?

 

 

b) If you are representing a company, please state the business activities it is involved in.

 

 

c) How many years has the company been in the business? __________________

 

d) In what geographical area are you interested to develop The Percy Institute of International Protocol License? Please specify.

_________________________________________________________________

 

e) Please indicate your interest accordingly:

 

  • I am interested to receive more information about The Percy Institute of International Protocol License
  • I would like to speak to someone from The Percy Institute of International Protocol. Please contact me
  • Others, please specify: _____________________________________________

 

We confirm that the information provided is true and correct and that The Percy Institute of International Protocol will rely on this information to assess the interest of my/our enquiry.

 

 

 

 

Signature: _________________________       Date: _______________________