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REGISTRATION FORM

PERSONAL DETAILS

Name : Shandra Kusuma Dewi

Home Phone : Komplek Bank Mandiri Cilandak, Jln. Inkaso nomor 4.


Cilandak Barat,
Jakarta Selatan.

Mobile Phone : 082227599493

E-mail : shandrakusumad@gmail.com

PROGRAM

Program Preparation for the GMAT – Basic Level

Starting Date Tuesday, August 07, 2018

Program Fee Rp. 3,500,000,-

PAYMENT

To register for this program, make a non-refundable down-payment of Rp. 500,000,-.

The balance payment of Rp. 3,000,000,- should be made by Thursday, August 02,
2018.

You can still register after Thursday, August 02, 2018, by directly making your full
payment..

Registration will close on Tuesday, August 07, 2018, at 12 noon.

Our account details for your program fees:

ABDUL AZIZ FAHRUDIN


BCA Mega Kuningan
Account 501 562 6272

REGISTER

To register, send this form back to PASCAL at info@pascaledu.com. Your registration will
be confirmed and guaranteed when we have received your down-payment.

Date : 03 Agustus 2018

Signature :

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