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Student's Full Name*

Student's Gender*

Student's Age*

Current School*

Student's E-mail Address

Parent's Name*

Parent's E-mail Address*

Parent's Mobile Number*

Number only without hyphen.

Food Allergies

Allergies description*

Payment Details

Payment Method (Online)
For payment, kindly bank in to the School's bank account:

Bank Name	CIMB Bank Bhd
Account No	8001749320
Account Name	Epsom College Malaysia Sdn Bhd
Swift Code / IBAN	CIBBMYKL

Payment

I am submitting the bank remittance advice together with this registration form.

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