Registration Form
Please ü the selected program required
Program Title / Date / Time / Day / Venue / Medium / Fee / Choice ü
1. / Are You An Anger Junkie? / 15 Jan 2011 / 9.30am - 4.30pm / sat / KMSPKS / English / $680
2. / Marriage with ‘S’ factor(2nd Run) / 18, 25 Feb, 4 Mar / 7.30-9pm / fri / KMSPKS / English / $99 (for both couples)
3. / Marriage with ‘S’ factor (3rd Run) / 1,8 & 15 Jul / 7.30-9pm / fri / KMSPKS / English / $99 (for both couples
4. / Marriage with ‘S’ factor (1st Run) / 1,8 & 15 Apri / 7.30-9pm / fri / KMSPKS / Mandarin / $99 (for both couples
5. / Certificate in Satir’s Transformational Systemic Therapy / 16, 23 Feb, 2,9, 23, 30 Mar / 7.30-9pm / wed / KMSPKS / English / $388
2 & 30 April / 9.30am-5.30pm / sat
6. / 青少年弟子规培训班 / 1st Jan – 29 Apr / 7-9pm / fri / KMSPKS / Mandarin / $20
Please fill in your particulars
Full Name in English: / Name in Chinese中文姓名: / NRIC No.:
Date of Birth: dd/mm/yy Age: / Sex : £ Male £ Female / Marital Status: £ Single £ Married
Address : S( ) / Email:
Mobile No.: / Home Tel No.: / Religion: / Signature …………………………………… Date: ……………………
Occupation: / Highest Qualification:
For Official Use
Mode of payment: £ Cash £ Cheque No. ______Total amount payable: S$______
Official Receipt No.: ______Date: ______Remarks: ______
Please make cheque payable to “Kong Meng San Phor Kark See Monastery”. Indicate “Program title" on the reverse side, together with your name and contact. 支票请写收款者"“Kong Meng San Phor Kark See Monastery”. 并在支票背后注明 “Program Title” 及您的姓名、
Mail to: Community Development & Training Department Kong Meng San Phor Kark See Monastery, 88 Bright Hill Road S574117。
Or simply pass your fully completed application form to the RECEPTION office in KMSPKS