MILLIONAIRES ACADEMY REGISTRATION FORM
SURNAME ----------------------------- OTHER NAMES --------------------------------------------------------------------------
RESIDENTIAL ADDRESS ---------------------------------------------------------------------------------------------------------
POSTAL ADDRESS ----------------------------------------------------------------------------------------------------------------
E-MAIL --------------------------------------- STATE OF ORIGIN ----------------------------------------------------------------
PHONE --------------------------------------------------------------- DATE OF BIRTH -------------------------------------------
SEX ----------------------- RELIGION--------------------MARITAL STATUS -----------------------------------------------------
ACADEMIC QUALIFICATION -----------------------------------------------------------------------------------------------------
LEVEL APPLIED FOR -------------------- PART TIME ------------ FULL TIME ---------------------------------------------------
ARE YOU SURE YOU WILL ATTEND ALL THE LECTURES? ----------------------------------------------------------------------
SPECIFY YOUR AREA OF INTEREST ---------------------------------------------------------------------------------------------
WHAT IS YOUR LIFE VISION? ----------------------------------------------------------------------------------------------------
HOW DO YOU FEEL ABOUT THE ACADEMY? ------------------------------------------------------------------------------------
SPECIFY YOUR AREA OF WEAKNESS --------------------------------------------------------------------------------------------
I ------------------------------------------------ SOLEMNLY PROMISE TO ABIDE BY THE RULES AND REGULATIONS OF THE ACADEMY.
STUDENT'S SIGNATURE AND DATE ---------------------------------------------------------------------------------------------
PARENT'S OR GUARDIANS SIGNATURE AND DATE ----------------------------------------------------------------------------
OFFICE USE
DIRECTOR OF STUDIES APPROVAL ---------------------------------------------------------------------------------------------
STUDENT NUMBER ----------------------------------------------------------------------------------------------------------------
OTHER INFORMATION ------------------------------------------------------------------------------------------------------------
DATE -------------------------------------------------------------------------------------------------------------------------------
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