BORANG PENDAFTARAN / REGISTRATION FORM

PROFESSIONAL & PERSONAL DEVELOPMENT WORKSHOPS

SEM 1 2010/2011
INSTITUTE OF POSTGRADUATE STUDIES

1. Nama (Name) : ____________________________________________________

2. No. Matrik (Matric No.) : ____________________________________________________

3. Pusat Pengajian (School) : ____________________________________________________

4. Warganegara : ____________________________________________________
(Nationality)

5. No. K/P /No. Pasport : ____________________________________________________

(IC No. /Passport Number)

6. Tel. bimbit : ____________________________________________________

(Handphone No.)

7. E-mel (E-mail) : ____________________________________________________

8. Program (Programme) : ____________________________________________________

Saya ingin mengikuti latihan berikut:

(I wish to attend the following course):

Title/Tajuk Date/Tarikh

i. RM 10.00

ii.

iii.

iv.

v.

________________________________

Tandatangan
(Signature)

SEKRETERIAT BENGKEL
U.P.: AMIRUL HAMDI
E-mel: ppd.ips.usm@gmail.com
Ext: 04-6532359

WORKSHOP SECRETARIAT
ATTENTION: AMIRUL HAMDI
E-mail: ppd.ips.usm@gmail.com
Ext: 04-6532359