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YAYASAN PERAK GRADPRENEUR KOHORT 3
Merupakan program kerjasama antara Kerajaan Negeri Perak dan Kementerian Pengajian Tinggi.
KOHORT 3
Tarikh: 19 - 28 September 2022
Tempat: Scholar's Suite Hotel, UPSI (Tg. Malim, Perak)
Maklumat lanjut boleh layari :-
www.yayasanperak.gov.my
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BORANG PENDAFTARAN / REGISTRATION FORM
1. Sila lengkapkan dan penuhkan butiran di bawah / Please complete and fill up the details below
2. Butiran yang diisi mesti betul dan benar / The required details must be correct
3. Tandakan yang berkaitan sahaja / Please select the related
NAMA PENUH / FULL NAME
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NO TELEFON
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ALAMAT RUMAH KEDIAMAN / HOUSE ADDRESS
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NO. KAD PENGENALAN / IDENTIFICATION CARD NO.
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JANTINA / SEX
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Lelaki / Male
Perempuan / Female
STATUS PERKAHWINAN / MARITAL STATUS
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Bujang / Single
Berkahwin / Married
Duda / Janda / Widower
BANGSA / RACE
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Melayu / Malay
Cina / Chinese
India / Indian
Other:
AGAMA / RELIGION
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Islam / Muslim
Hindu / Hindu
Buddha / Budhist
Kristian / Chistian
Other:
DAERAH / DISTRICT
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Kinta
Hilir Perak
Hulu Perak
Larut, Matang & Selama
Kerian
Kuala Kangsar
Perak Tengah
Manjung
Kampar
Batang Padang
Muallim
Bagan Datuk
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