ONLINE COURSE REGISTRATION FORM

1. Full name:
2. Date of birth: 3. Gender:
4. Have you previously been enrolled in any English classes:
5. Email: 6. City:
7. Mobile phone: 8. Course:
______________________ a. ESL
______________________ b. IELTS
c. TOEFL
* Please be noted that we only provide Speaking class for Online course
9. Available time and days :
(1 hour per class)
10. Available time and day for level test and trial class:
(1hour per class)
11. Registration period: (dd/mm/yy)
from______________to________________
Signature Date

Sent by ______________company

For KATA Academy:

1. Account for trial class:
2. Confirmed trial class date and time:
3. Teacher in charge:

Officer in charge Date