Application form for Acupuncture Courses
To,
The Registrar
Research Institute of Medical Acupuncture, Malaysia (RIMAC)
Lot 122, Open University Campus
Kampong Gelang Mas, 17010 Pasir Mas, Kelantan, Malaysia.
Tel: 012-9554975 or 09-7972948, Fax 03-26983242
Nature of Course: Basic / Diploma / Master
Name of Applicant:..........................................................................
Full Postal Address:.........................................................................
...............................................................................................................
................................................................................................................
Date of Birth:....................................I/C No:.......................................
Tel:.................................. .Res.......................................office
E Mail:...................................................................................................
Send this form along with:
Bank Draft / Money order in favor of Research Institute of Medical Acupuncture
3 passport size photograph
Supported document : certificate / Diploma / degree - photostat copy.
Date:.................................................. Signature:.................................................
P/S: Fee paid are non refundable