Friday, 21st November 2008
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REGISTRATION FORM
PERSONAL DETAILS
Fields marked with * are mandatory
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Mr
Mrs
Miss
Name*
Email*
IC/Passport*
Sex
Male
Female
Date of Birth
Nationality
Malaysian
Non Malaysian
Contact Address*
City
State
Postcode
Tel No*
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Fax
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Mobile
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Company Name
Occupation
Tel No
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Highest Academic Qualification
Phd
MSc
Degree
Diploma/Advance
STPM / O Level
SPM / A Level
Others
PARENT / GUARDIAN DETAILS
Name of Father/guardian
Relationship
Address
City
State
Postcode
Tel No
H/P No
Fax No
ACCOMODATION
Shared house and apartments are the most common form of student housing, allowing students to save on costs and develop friendship. Please tick the following:
I want accomodation booked for me
Yes
No
COURSE PREFERENCES
Level
Certificate
Diploma
Advanced Diploma
Degree
MSCE
MCSD
Programmes
Information Technology
Sales & Marketing
Graphic Design
E-Business
Accounting & Finance
Medical Lab Technology
Business Management
E-Secretaryship
Multimedia
Nursing
Entrepreneur Development
Hospitality & Tourism
Culinary Arts
Others
STATISTICAL DETAILS
How did your hear of the Institute
Direct Enquiry
Exhibition / Seminar
Newspaper
Flyers
Radio /TV
Friend / Relative
Website
Others, please specify
DECLARATION
1. I declare that the information provided by me is true and complete.
2. I agree that all fees paid are not REFUNDABLE nor TRANSFERABLE.
3. I agree to abide by the rules and regulations of the institute as stated in the student handbook.
Signature*
(Please insert your name)
Date
Note : Please only check appropriate and applicable boxes
