KLMU - Online Enquiry Form



		Thursday : 11th March 2010

Online Enquiry Form

REGISTRATION FORM

PERSONAL DETAILS

Fields marked with * are mandatory.

Mr

Mrs

Miss

Name*

Email*
IC/Passport*

Sex

Male

Female

Date of Birth

Nationality
Contact Address*

City

State

Postcode

Tel No*

-

Fax

-

Mobile

-

Company Name

Occupation

Tel No

-

Highest Academic Qualification

Phd

MSc

Degree

Diploma/Advance

STPM / O Level

SPM / A Level

Others

PARENT / GUARDIAN DETAILS

Name of Father/guardian

Relationship

Address
	City	State
	Postcode	Tel No
	H/P No	Fax No

ACCOMODATION

Shared house and apartments are the most common form of student housing, allowing students to save on costs and develop friendship. Please tick the following:

I want accomodation booked for me

Yes

No

COURSE PREFERENCES

Level

Certificate

Diploma

Advanced Diploma

Degree

MSCE

MCSD

Programmes

Information Technology

Sales & Marketing

Graphic Design

E-Business

Accounting & Finance

Medical Lab Technology

Business Management

E-Secretaryship

Multimedia

Nursing

Entrepreneur Development

Hospitality & Tourism

Culinary Arts

Others

STATISTICAL DETAILS

How did your hear of the Institute

Direct Enquiry

Exhibition / Seminar

Newspaper

Flyers

Radio / TV

Friend / Relative

Website

Others, please specify

DECLARATION

1. I declare that the information provided by me is true and complete.

2. I agree that all fees paid are not REFUNDABLE nor TRANSFERABLE.

3. I agree to abide by the rules and regulations of the institute as stated in the student handbook.

Signature * (Please insert your name)

Date

Note : Please only check appropriate and applicable boxes