registration form of toeic test new
DESCRIPTION
Bisa dugunakan bagi yang mau Test TOEIC Di SurabayaTRANSCRIPT
TOEIC Test Simulation
TOEIC Certified Test Administration Site
WIDYA MANDALA LANGUAGE INSTITUTE Graha Widya Mandala, 4th Floor, Jalan Dinoyo 48 A, Surabaya 60265 East Java - Indonesia Phone/Fax: +62-31-5682681, Website: www.wmli.org, Email: [email protected]
TOEIC TEST REGISTRATION FORM1. Name:_________________________________________________________________2.Identity Card Number:_________________________________________________________________3.Date of Birth:_________________________________________________________________4.Company Name:_________________________________________________________________5.Position:_________________________________________________________________6.Company Address:_________________________________________________________________ City:_________________________________________________________________ Phone Number:_________________________________________________________________ Fax Number:_________________________________________________________________7.Home Address:_________________________________________________________________ City:_________________________________________________________________ Phone Number:_________________________________________________________________ HP Number:_________________________________________________________________ Email:_________________________________________________________________
8.Test Fee: Rp 600.000,- (classic) / (redesigned), 1 Score Report
9.Extra Score Report: Rp 120.000,-/copy
.Certificate: Rp 200.000,-/copy
10.Payment:
Cash Bank Transfer
(5 days before test date)
(Please transfer to our account at Bank Mandiri- Ester Widawati T. Lembaga Bahasa Widya Mandala, Acc no. 1400011869758)11.Test Date: _________________________________________________________________ Surabaya, _____________________________(
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Signature and Name