SOBAT ENGLISH COURSE

Let’s Learn and Speak English

Registration Form
Student Details
(Data Siswa/i)
Name
(Nama) : ...………………………………………………………………………
Surname
(Nama Panggilan) : ..………………………………………………………………………
Place and Date of
Birth : ...……………………………/…………………/ /
(Tempat Tangga Lahir)
Address
(Alamat) : ...………………………………………………………………………
Mobile Number
(Nomer HP) : ...………………………………………………………………………
First Language
(Bahasa Pertama) : INDONESIAN SUNDANESE JAVANESE ETC
Gender
MALE FEMALE
(Jenis Kelamin) :
Emergency Contact
(Kontak Darurat/Wali)
Name
(Nama) : ...………………………………………………………………………
Relationship to You
PARENTS BRO/SIS FAMILY ETC
(Hubungan) : ...………………………………………………………………………
Mobile Number
(Nomer HP) : ...………………………………………………………………………
Email Address
(Alamat Email) : ...………………………………………………………………………
GENERAL ENGLISH Beginner Elementary Pre Intermediate
Intermediate Upper Intermediate Advanced
ENGLISH FOR CHILDREN Basic English

Part-Time Standard Intensive

8 Meeting/Month Rp.50.000, 12 Meeting/Month Rp.50.000, 16 Meeting/Month Rp.60.000,

Student Signature