EmailMe Form - Dynamic Language Center Application Form

Language of Interest? *

DLC Campus Applying to: *

Bayan Lepas Campus

Butterworth Campus

Full Name *

IC/Passport Number *

Phone Number *

Email *

Nationality *

Address in Malaysia

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

In case of an emergency, please contact:

Enter the name, relationship to you and phone number of that person

How did you hear about DLC? *

Questions or other information you may want to ask Dynamic Language Centre: (optional)

Declaration by Applicant *

I declare that the information given is true and complete. I understand that any misrepresentation of information may result in Dynamic Language Centre (DLC) revoking acceptance or terminating my enrollment.