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Mikkomike Integrated Global Services
Head Office: Ebis Road Amarata, Yenagoa, Bayelsa State, Nigeria
Tel. +2347051922587, +23408103648772
Email:
mikkomike.migs@gmail.com
Website:
www.migs.ecwid.com
Seminar/Event Registration Form
Personal Details
Name:
Your answer
Address:
type your exact address that can be located.
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Phone Number
Your answer
Email:
Your answer
Gender:
Male
Female
Clear selection
Home Town:
Your answer
City:
Your answer
L. G. A:
Your answer
State:
Your answer
Marital Status:
Married
Single
Divorce
Clear selection
Nationality:
Your answer
Seminar/Event Choice(One or Both)
Mini Importation Guide
Free Tuition University & Full Scholarship Guide
Declaration:
1
Your answer
hereby declare that, by submitting this form, i, agreed to abide by the rules and regulations as well maintain the code of conducts to ensure the smooth running of the SEMINAR/EVENT
Note: print out the form after filling it and come with it to the seminar venue on 19th September, 2015 at 9:00am only if you do not have a receipt of payment.
Special Need (Optional)
If you are paying for a specific need state it here
Your answer
Submit
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