IJMB

IJMB Registration Form


PERSONAL DATA

SURNAME:		OTHER NAMES:

ADDRESS:

TELEPHONE:		EMAIL:

DATE OF BIRTH:		PROOF OF NAME: e.g Drivers Licence No.

EDUCATION HISTORY

NAME OF INSTITUTION(S) ATTENDED WITH DATE(S)
	1.		If you are combining O/L & A/L, you can pick a maximum of 2 O/L and 3 A/L or 3 O/L and 2 A/L. Ensure there is no time-table clashes. You can not pick the same subject at both levels e.g O/L Mahts and A/L Maths

	2.

	3.

CERTIFICATES / DIPLOMA OBTAINED
	1.

	2.

	3.

CHOICE OF SUBJECTS (ORDINARY LEVEL)		CHOICE OF SUBJECTS (ADVANCED LEVEL)

SUBJECT 1		SUBJECT 1
SUBJECT 2		SUBJECT 2
SUBJECT 3		SUBJECT 3
SUBJECT 4
SUBJECT 5
SUBJECT 6

PAYMENT DETAILS

			Please include all payment details here such as Bank Name, Teller No. etc.