Atlas Education Services | PT. Atlas Ekamatra Saptajasa Contact Us
Competition Application Form
 
 
 
 
 
 
 
 
 
 
 


Fill the form and join the competition!

Name: :
Email: :
Date of Birth: :
Home Address: :
Home & Cellular Phone: :
Parent's Name: :
Are you CosmoGirl subscriber? :   Yes No
How do you get your CosmoGirl? :
Where did you see the announcement? : Poster
Magazine
Radio
If you answered poster please state where you saw the poster :
Have you been abroad? :
Do you have any family who lives abroad? :
Have you ever joined a summer program abroad? :
If you answered yes please specify the country :
Are you interested in learning other language beside English? :
What is the possibility of you studying abroad? : After High- School
After University
No chance
Don't know yet
What subject interests you? :
Which country would you most likely to go for holiday program (e.g. summer school? : UK
USA
Australia
Singapore
Canada
South Africa
Others
Do you have other country of preference? :
If you signed up for Summer Holiday in 2003, how much is your budget allowance? : 1500 - 2000
2001 - 2500
2501 - 3000
>3000

Did you fill up this questionnaire with the your parents consent? (please be honest)

:
   
Sponsored by:


TOP