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Full Name

First

Last

Date of Birth (Day-Month-Year)

Gender

Nationality

Permanent Address

Phone Number

Email Address

Confirm Email

Language Choice

Language Type

Level of Study

Preferred Learning Mode

Preferred Class Schedule (Lecture Time will be flexible for both the instructors and learners)

Preferred Class Days

Preferred Start Date (Day-Month-Year)

Additional Notes from Client for Service Request (IF ANY)

Highest Qualification Obtained

Past Language Learning Experience (if any)

Why do you want to learn this language?

How do you intend to use the language?

Emergency Contact Name

Emergency Contant Phone Number

Emergency Contact Email

Emergency Contact Relationship

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