Application Form
SCHOOL OF PROFESSIONAL AND CONTINUING EDUCATION

BLUE PILLAR ACADEMY
7517(1st Floor), LORONG SERI TANJUNG 1, TAMAN REGENSI OREN, 13400 BUTTERWORTH, PULAU PINANG.


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Email *
Programme *
Personal Particular
Full Name (as per IC/Passport)
*
Identification No.
*
Date of Birth *
MM
/
DD
/
YYYY
Telephone No. 
*
Email (We will email invoice/receipt/recorded video to this email address)
*
Gender
*
Required
Marital Status *
Citizenship
*
Required
Correspondence address (Important documentation or study material will be sent to this address)
*
Permanent Address (If the address matches the correspondence address, simply state: "Same as correspondence address.") *
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