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CAMPUS REGISTRATION FORM JOUBERTON KLERKSDORP MATLOSANA POTCHEFSTROOM TAUNG STUDENT NUMBER FOR OFFICE USE ONLY Please complete the entire form in print. TYPE OF STUDENT Private Mark with an X where applicable. Staff Employer NCV FEA MAR OA MAN HOSP OTHER NATED TOUR CIVIL EIC ERD IT BASS HR ELECT MECH L/SHIP SKILLS FK ECD HAIR A STUDENT INFORMATION DATE OF BIRTH ID NR TITLE Mr Ms Other Specify C Y M INITIALS SURNAME FULL NAMES FIRST TEL SECOND CELL THIRD DAY TEL FOURTH PASSPORT NUMBER FOREIGN...

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NAME: S: Surname: ST: STn: PHW: PHD: DATE OF ENROLLMENT: DURATION OF ENROLLMENT: FIRST CLASS TRAVEL INSTRUCTIONS: PHONE NUMBERS: FAX: S/HEART: DOB: DOK: ESSENTIAL TRAINING: EMPLOYMENT AFFILIATION: PHONE NUMBERS: FAX: S/HEART: DOB: DOK: A: RENOWN: RANGE: ILLINOIS STATE REPRESENTATIVE DISTRICT: POC: LOCATION: COUNCIL DISTRICT 4 POLITICAL PARTY REPRESENTATIVE DISTRICT: HOSPITALITY REPRESENTATIVE 2-5-12 CITY COUNCIL DISTRICT 13 COUNCIL DISTRICT 18 COUNCIL DISTRICT 20 COUNCIL DISTRICT 23 COUNCIL DISTRICT 24 COUNCIL DISTRICT 25 COUNCIL DISTRICT 27 COUNCIL DISTRICT 28 COUNCIL DISTRICT 3 COUNCIL DISTRICT 3-11 CITY COUNCIL DISTRICT 13 COUNCIL DISTRICT 17 COUNCIL DISTRICT 21 COUNCIL DISTRICT 32 COUNCIL DISTRICT 40 COUNCIL DISTRICT 42 COUNCIL DISTRICT 43 COUNCIL DISTRICT 45 COUNCIL DISTRICT 47 COUNCIL DISTRICT 49 COUNCIL DISTRICT 50 COUNCIL DISTRICT 5 COUNCIL DISTRICT 5-4 COUNCIL DISTRICT 5 COUNCIL DISTRICT 5-4 COUNCIL DISTRICT 6 COUNCIL DISTRICT 6-6-3 COUNCIL DISTRICT 7 COUNCIL DISTRICT 7-8 COUNCIL DISTRICT 8 COUNCIL DISTRICT 9 COUNCIL DISTRICT 10 COUNCIL DISTRICT 11 COUNCIL DISTRICT 36 COUNCIL DISTRICT 40 CITY COUNCIL DISTRICT 11 COUNCIL DISTRICT 12 CITY COUNCIL DISTRICT 12-1 CITY COUNCIL DISTRICT 12-1 COUNCIL DISTRICT 13 COUNCIL DISTRICT 23 COUNCIL DISTRICT 27 CITY COUNCIL DISTRICT 27 COUNCIL DISTRICT 27-1 COUNCIL DISTRICT 29 COUNCIL DISTRICT 51 CITY COUNCIL DISTRICT 32 CITY COUNCIL DISTRIC 6 COUNCIL DISTRIC 10 CITY DISTRIC 11 COUNCIL DISTRICT 10 COUNCIL DISTRICT 11-3 COUNCIL DISTRICT 16 COUNCIL DISTRICT 26 COUNC

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