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Jejak Ilmiah Victoria 2008

Application form for Jejak Ilmiah Victoria 2008 program.

Name * First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone
University

eg; Monash University
Course & Year

eg; BE Electrical/ 3rd year
Course details *
Pengenalan Ilmu Syariah Islamiyyah (Ustazah Syaripah Nazirah, 9.00am-10.30 am) Al-Quran & Tajwid (Ustaz Khairul, 10.30am-12.00pm) Sirah (Ustaz Nushi Mahfodz, 2.00pm-3.30pm) Akhlak (Ustaz Haznizul, 3.30pm-5.00pm)

Please tick which subject you would like to enroll. Tick all boxes if you wish to enroll in all subjects.
Payment options ( AUD 10 to cover all administrative costs) *
Bank direct deposit ( we will contact you later for bank account details) Pay on the day of registration

We will contact you later for payment via bank direct deposit, to give you the bank account details. Thank you.
Do Not Fill This Out
Do Not Fill This Out