EmailMe Form - MKLAV - Registration Main Program

Personal Information

Full Name *

Please enter your name for Certificate

Date of Birth *

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

Mobile for Whatsapp *

Email *

This registration form will be send to your email, please make sure you have entered the correct email address.

Emergency Contact

Full Name *

Mobile *

Digital Information

Website

Instagram *

Facebook *

Twitter

Formal education

Institution *

Your last formal education

Major / Minor *

Year *

Non-formal education related to fashion

Institution

Related with fashion

Year

Experience related to fashion

Experience(s)

Payment Confirmation

Please register me to *

I'm registering to Fashion Design with Collection, I'd like to make payment *

By selecting the above selection, you agree to register in MKLAV Fashion Design with Collection Program and pay the selected course fee

This registration form also served as an INVOICE for your registration and it will be send to your email.

Please transfer your payment to PT Moda Kreasi Laras Visi. The account number will be sent to your email once you submit this form.

All payment is non-transferable, non-refundable and valid for 9 months.

I'm registering to Fashion Design, I'd like to make payment *

By selecting the above selection, you agree to register in MKLAV Fashion Design Program and pay the selected course fee

This registration form also served as an INVOICE for your registration and it will be send to your email.

Please transfer your payment to PT Moda Kreasi Laras Visi. The account number will be sent to your email once you submit this form.

All payment is non-transferable, non-refundable and valid for 6 months.

I'm registering to Mini Collection, I'd like to make payment *

By selecting the above selection, you agree to register in MKLAV Mini Collection Program and pay the above course fee

This registration form also served as an INVOICE for your registration and it will be send to your email.

Please transfer your payment to PT Moda Kreasi Laras Visi. The account number will be sent to your email once you submit this form.

All payment is non-transferable, non-refundable and valid for 12 months.

I'm registering to Garment Construction, I'd like to make payment *

By selecting the above selection, you agree to register in MKLAV Garment Construction Program and pay the above course fee

This registration form also served as an INVOICE for your registration and it will be send to your email.

Please transfer your payment to PT Moda Kreasi Laras Visi. The account number will be sent to your email once you submit this form.

All payment is non-transferable, non-refundable and valid for 6 months.

I'm registering to Fashion Illustration, I'd like to make payment *

By selecting the above selection, you agree to register in MKLAV Fashion Illustration Program and pay the above course fee

This registration form also served as an INVOICE for your registration and it will be send to your email.

Please transfer your payment to PT Moda Kreasi Laras Visi. The account number will be sent to your email once you submit this form.

All payment is non-transferable, non-refundable and valid for 6 months.

I'm registering to Weekend Workshop Series, I'd like to make payment *

By selecting the above selection, you agree to register in MKLAV Weekend Workshop Series and pay the above course fee

This registration form also served as an INVOICE for your registration and it will be send to your email.

Please transfer your payment to PT Moda Kreasi Laras Visi. The account number will be sent to your email once you submit this form.

All payment is non-transferable, non-refundable and valid for 6 months.

I'm registering to 3-Day Workshop, I'd like to make payment *

By selecting the above selection, you agree to register in MKLAV 3-Day Workshop and pay the above course fee

This registration form also served as an INVOICE for your registration and it will be send to your email.

Please transfer your payment to PT Moda Kreasi Laras Visi. The account number will be sent to your email once you submit this form.

All payment is non-transferable, non-refundable and valid for 3 months.

Your Name *

Type your name as an agreement to register

Confirmation *

I agree

The above informations are true and I understand fully the terms and conditions applied. The information provided can be use for MKLAV Academic purposes