Student Registration Form

Course Title:
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Personal Details

Surname
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Other Names
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Phone Number
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Address
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Email Address
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NIC No
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Field is required!

Contact Person’s details in case of emergency (Responsible-Party):

Responsible-Party’s Name
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Field is required!
Relationship to Responsible-Party
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Field is required!
Address
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Field is required!
Phone Number
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Field is required!
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Please tick

Call on 59639030 for assistance.

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