Class Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student E-mail
Mobile Number

Area CodePhone Number
Phone Number

Area CodePhone Number
Work Number

Area CodePhone Number
Company
Courses
Additional Comments
CAMBRIDGE ENGLISH COURSE BLITAR
URGENT!

You still need to come to the CEC office for cash payment (registration, DP 60% or full payment). If you pay by transfer please send the evidence of transfer to whatsapp. Thank you.
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Student Registration Form