Pre-University Seminar 2015

Registration form
School:

Name (as in NRIC):

Please insert a
scanned recent
photograph in this
box.

NRIC number:

Citizenship:

Ethnic group:

Mobile number:

E-mail address:

Blood group:

Dietary requirements
(please circle accordingly):

[300 to 500 dpi]

Sex: M/F

T-shirt
size:
XS/S/M/L/XL

Non-vegetarian/ Vegetarian
*All meals are Halal
If you have any allergies, existing medical conditions, significant medical history, or other special
needs, please indicate them here:

Please provide the following information, which will be important in the event of an
emergency.
Name of next-of-kin (as in NRIC):
Relationship:

Mobile number:

Home number:

Office number:

E-mail address:
NOTE:
o
o

Please e-mail the completed form to preusem2015@sajc.sg by 6 March 2015 .

Hardcopies are to be submitted on 28 March 2015 (Pre-Seminar Workshop)
Schools ARE NOT to change or withdraw their participants after they have been registered. However, if
exceptional circumstances make changes absolutely necessary, Teacher Advisors should e-mail the
personal particulars of new participants latest by 20 March 2015, after which no further changes can be
made.