Registration Form

LK AYURVEDA RESEARCH TRAINING ACADEMY (M) SDN BHD Company No: 1082554-W
No. 11 & 12 Tingkat Atas, Taman Pundut Raya, Jalan Lumut, 32200 Lumut, Perak
Tel / Fax: 05-683 8162 H/P: 016-246 5474
email: lkacademy16@gmail.com website: www.munu2u.com
REGISTRATION FORM
(Malaysian Student)

Full Name (as in IC) : *

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Race : *

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Date of Birth : *

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Marital Status *

Mobile Phone : *

Email *

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Monthly Income : *

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Occupation :

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School / University *

Last Qualification *

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Job Title *

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COURSE APPLIED FOR *

FINANCIAL *

Contacts

LK Ayurveda Research Training Centre & Pusat Rawatan Naturopati
No 20, Batu 3, Pundut,
Jalan Lumut,
32200 Lumut
Perak.
Tel : 05-6838162
WhatsApp : 016-246 5474