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  • Registration Form IAG Dec 2013

    Uploaded by

    Liesa Kannisius
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    The document appears to be an application form for various programs offered by PT. Adam Khoo Learning Technologies Group between December 17-22, 2013, including the IAG Jr program for ages 9-13, IAG Sr program for ages 14-20, and possibly a Special Coaching Program. The application requests personal details of the participant such as name, date of birth, school/grade, contact information, and parent/guardian details. By signing, the participant or parent agrees to the terms and conditions set by the organization.

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    The document appears to be an application form for various programs offered by PT. Adam Khoo Learning Technologies Group between December 17-22, 2013, including the IAG Jr program for ages 9-13, IAG Sr program for ages 14-20, and possibly a Special Coaching Program. The application requests personal details of the participant such as name, date of birth, school/grade, contact information, and parent/guardian details. By signing, the participant or parent agrees to the terms and conditions set by the organization.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views1 page

    Registration Form IAG Dec 2013

    Uploaded by

    Liesa Kannisius
    The document appears to be an application form for various programs offered by PT. Adam Khoo Learning Technologies Group between December 17-22, 2013, including the IAG Jr program for ages 9-13, IAG Sr program for ages 14-20, and possibly a Special Coaching Program. The application requests personal details of the participant such as name, date of birth, school/grade, contact information, and parent/guardian details. By signing, the participant or parent agrees to the terms and conditions set by the organization.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
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    of 1

    B

    Your Program Consultants Name:

    APPLICATION FORM
    Program

    Dates

    IAG Jr (9-13 Yr)

    18-22 Dec 2013

    Danny Tanoto / 087788520752

    Title of Free Book(Data Filled by Officer)


    Price

    Payment

    OFFICIAL USE

    I am Gifted

    Sign Up Venue

    Office

    Rp

    IAG Jr + SCP
    IAG Sr (14-20 Yr)

    Preview
    Rp

    1721 Dec 2013

    IAG Sr + SCP
    For group of 5, please write down other participants name in your group:

    1. ___________________________________

    Special Remarks:

    2.___________________________________
    3.___________________________________

    Part I :

    Participant Particulars

    Name

    ID / Passport No.

    Date-of-Birth
    (dd/mm/yyyy)

    School: ___________________________________________________________
    Nationality: ___________________________

    Grade/Class: _______________________________________

    Religion: ___________________________________ Gender: Female / Male (circle accordingly)

    Email: ________________________________________________________________________________________________________________
    Address
    Postal Code

    Contact No. (Mobile)


    Contact No. (Home)

    Fax No.

    Part II:

    Parent/Guardian Particulars

    Dad
    Mobile No.
    Dad

    Company . Position ...

    Email
    Mom
    Mobile No.
    Mom

    Company . Position ...

    Email

    Part III :

    To be signed by Participant (Parent/Guardian is required to sign on the behalf of their child)


    PT. Adam Khoo Learning Technologies Group (PT. AKLTG) reserves the right to make changes without prior notice.
    I have read and understood the Terms & Conditions stated by AKLTG and agree to abide by them.

    Signature of Applicant / Parent / Guardian

    Date (dd/mm/y)

    ____________________________________

    _____________

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