Registration for Yoshimoto Orton-Gillingham Approach English

(Philippines): 19 - 23 November 2018 (Mon to Fri)

This form may take you 20 minutes to complete.

Please fill in the details below and submit the completed form to us.

1 PERSONAL DETAILS - Please complete the following

Name Age
(Kindly fill your name in uppercase, as this name will be reflected on the certificate.)

NRIC/ Passport No Sex F M

Address

Mobile Email (1)

Home Email (2)

Office

2 EMPLOYMENT DETAILS - Please check the category you belong to (you may tick more than one)

Parent

Teacher Tutor
(Pls provide name of school) (Pls specify grade level)

Other Professional (Pls tick 1 of the following options)

Psychologist Counsellor Speech/Language OT administrator

None of the above

(Pls explain why you are keen to take up this course)

Current employer

Education/ Degree

(Please indicate course of study and institution)

What is your teaching experience? (if any)

Rate your degree of proficiency in English Poor Fair Good Excellent

M S L Consultancy Pte Ltd Tel: 6733 4188

(Co. Reg. No. 201010768G) Email: info@msl-orton.com
19 Tanglin Road URL: www.msl-orton.com
#11-05 Tanglin Shopping Centre
Singapore 247909
 3 OTHERS - Please complete the following

Please check your reason(s) for wanting to take the course (you may tick more than one)

To help my child

(Pls provide details on child)

To facilitate my teaching of students in mainstream schools

For career advancement

(Pls provide details)

Seeking a career change

(Pls explain why you are keen to be an educational therapist)

For personal development

(Pls provide details)

Others

(Pls provide more info)

4 HOW DID YOU FIND OUT ABOUT US?- Please complete the following

Referred by

Online advertisement

Online search

Facebook

M S L Consultancy Pte Ltd Tel: 6733 4188

(Co. Reg. No. 201010768G) Email: info@msl-orton.com
19 Tanglin Road URL: www.msl-orton.com
#11-05 Tanglin Shopping Centre
Singapore 247909
COURSE DETAILS - Please take note of the course details

Course Dates Fees

19 - 23 November 2018 (Monday to Friday) Registration Fee S$350 (non-refundable)

Course Fee S$2,600
Total Fees payable S$2,950

Training Venue

(to be advised)

PAYMENT - Please check the mode of payment and the details

Cash Amount Date

Bank Transfer Amount Date

Cheque Amount Date

(Cheque is to be made payable to “M S L Consultancy Pte Ltd”. UOB 451-305-160-8)

Please mail form and payment to

19 Tanglin Road
#11-05 Tanglin Shopping Centre
Singapore 247909

TERMS & CONDITIONS

• Please note that places in the course are available on a first-come-first-served basis.
• All applicants will be considered on a case-by-case basis and may be required to go through an interview before
acceptance.
• M S L Consultancy Pte Ltd reserves the right to turn down any applicants and the management decision is final.
• No substitution or transfer of participation is allowed.
• Registration fee will only be collected from the participant upon formal acceptance into the training intake.
• A participant is considered formally registered only when the registration fee is received by M S L Consultancy
Pte Ltd.
• Registration fee is non-refundable.
• All course fees must be paid in full at least six weeks before the commencement of the course.

I hereby declare that I have read the above terms & conditions and that all the entries are true
and correct.

Signature Date

M S L Consultancy Pte Ltd Tel: 6733 4188

(Co. Reg. No. 201010768G) Email: info@msl-orton.com
19 Tanglin Road URL: www.msl-orton.com
#11-05 Tanglin Shopping Centre
Singapore 247909