Australian Mathematics Competition

2014

Individual Registration Form

(Please return this form before 14 April 2014)
[Competition Date: 7 August 2014 at 11 a.m.]
Student's Name :

(English )
(Chinese )

Sex

Date of Birth
(dd/mm/yyyy)

School Name

Female

Male
IC / Birth Certificate No
/:

(English )
(Chinese )

Category

Medium

Primary
Standard 3
Standard 5

Standard 4
Standard 6

Secondary
Form 1
Form 3
Form 5

Form 2
Form 4
Form 6

English

Chinese (Simplified) ()

(English )

Parent's/Guardian's Name
/

(Chinese )

Relationship

Father

Address

Postcode

Town/City :

State

Fax :

Phone Number / :
Registration Fee

Mother

E-mail

Guardian

RM 40

Payment Bank :
Cheque Number :
* Please make the cheque / bank draft payable to
NEW ERA COLLEGE
Please send the registration form together with photocopy of IC / Birth Certificate and the payment to / bank-in to
// :
Department of Information Sciences and Computer Studies (DISCS)
New Era College
Lot 5, Seksyen 10, Jalan Bukit, 43000 Kajang, Selangor.
Tel : 03-8739 2770 Ext 418, 421
Fax : 03-8733 6799
E-mail : amc@newera.edu.my
Website : www.newera.edu.my/discs/amc
Bank : OCBC Bank (Malaysia) Berhad
Account No: 706-103710-6
Parent's/Guardian's Signature / :
Date :
(Ref: AMC 2C/2014)