Please be aware that by completing this On-line Registration form, you are
bound by the Subscriber Agreement. See Terms and Conditions for more information.

Please Fill In the Sections Below Before You Submit Your Registration.
We will send you e-mail with your membership and access information after Submission.
(Please provide a valid email address)

For further enquiries please contact:

Mr. Fuad
Tel: 03-7047008
Fax: 03-7047002
email : admin@learnability.com.my

I would like to subscriber to nasionet Learnability online education for month(s) @ RM 40 per month.

User Particulars
Name (in FULL) :
email Address :
(Please provide a valid email address)
NRIC/Passport :
Home Address :
City/Town :
State :
Post Code :
Telephone :
Fax :
Age Group:
 Below 18 18 - 21 22 - 25 26 - 30 31 - 40 41 - 55 Above 55
Company/Organization :
Office Address :
Platform:
 Windows 95/98
Windows 3.1X
Others
Addition Information :



** Please enter your preferred learnability login user name.
The name you enter here cannot be changed later, so please choose your name carefully
and meaningfully as this name will be appeared on your E-mail address as well.
The number of characters must not be less than 3 or more than 15.
(ONLY Lower Case Letters And Digits Are Allowed)

 Login User Name :



Payment Method:
Cross Cheque/Money Order (made payable to "Swiftcom Sdn. Bhd")

notes: If we fail to receive your cheque within 7 days, we will proceed to terminate your a account without prior notice.

Cheque/Money Order Detail

 Cheque/Money Order Amount : RM
Cheque/Money Order Number :
Name of bank/branch :

Please send your cheque/Money Order to :

Swiftcom Sdn Bhd
 403, 2nd Floor
Block A, Glomac Business Centre
10, Jalan SS6/1
47301 Petaling Jaya
Selangor Darul Ehsan

Credit Card
Please print out the online form, fill it out and fax it back to : 603-704 7002 ; Otherwise, please contact Mr. Fuad at 603-704 7008, we will fax you a copy of the authorization form, Thank you.

Please contact us at 603-704 7008 or email for any further enquiries.



I have read, understand the Terms and Conditions and agree to be bound by it.
Please double check all details before you sign up




© 1999 Swiftcom Sdn. Bhd.