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Registration Form VRC English Course

(Formulir Pendaftaran)
Full Name

(Nama Lengkap)

Place and Date Birth

(Tempat Tanggal Lahir)

Nick Name

(Nama Pangggilan)

Name of School

(Nama Sekolah)

Class

(Kelas)

Addresss

(Alamat)

PROGRAM

Course

Time

Vocabulary

M-W-F

Understanding

Aft (16.00-17.30)

Daily Conversation

Eve (18.45-20.15)

1 Program = Rp. 100.000,00

First Payment :

2 Program = Rp. 150.000,00

Accepted By

T-T-S

3 Program = Rp. 200.000,00

RECEIPT
(Kuitansi)
Applicant (pemohon)
Accepted By (diterima oleh)
Payment

Makassar,
Applicant

2015
Officer

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