LANGUAGE AND CONSULTANCY UNIT LANGUAGE ACADEMY UTM JOHOR BAHRU

REGISTRATION FORM LANGUAGE AND COMMUNICATION COURSES

Last (family/surname) name

Title (Dr/Mr/Mrs/Miss/Ms)

First (given) name (s)

(These names must be the same as the names on your passport/ national identity card and must appear in the same order) Address:

Telephone/ Mobile number

Gender F Status: UTM Student ( RM250) UTM Staff (RM350) Public (RM450) M

Please indicate which document you will be using as proof of identity given below: Passport For office use only: Cancellation Policy: Full Refund: A week before class starts (Course fee only) Class cancelled by Language Academy 50% refund: Less than a week before class starts (course fee only) No Refund: - Once class has started National Identity Card

Submitted by : Received by Date : :

LANGUAGE AND CONSULTANCY UNIT LANGUAGE ACADEMY UTM JOHOR BAHRU

Copy for candidate: Cancellation Policy: Full Refund: A week before class starts (Course fee only) Class cancelled by Language Academy 50% refund: Less than a week before class starts (course fee only) No Refund: - Once class has started

Submitted by : Received by :

Date