Attendee Registration Form – Mokopane Matric Rewrite Center

Student - Surname *

Student - Preferred Name *

Student - Gender *

Student - Home Language *

Student - Last School Attended *

Student - Full Names *

Student - ID Number *

Student - Cell No *

Student - Race *

Student - Year *

Student - Any Sicknesses

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If any serious sicknesses, please explain briefly.

Student - Examination Number * Examination number on your statement of the last time you sat as a full time matric student.

Student - T-Shirt Size *

Emergency Contact Person Details

How did you know about MMR? *

Emergency Contact - Name and Surname *

Emergency Contact - Relationship to Student *

Available Programmes and Fees

Emergency Contact - ID Number *

Emergency Contact - Cell No *

Select a Programme *Amended - 6 Months Contract
Supplementary - 6 Moths Contact
MEO - 6 Months Contract
(Note: All fees must be paid in full by the 3rd of May in order to receive your examination time table)
Repeat - 11 Months Contract
(Note: All fees must be paid in full by the 3rd of Oct in order to receive your examination time table)

Fees *(Please Note: With the 5 Subject option Only, a 6th Subject can be added for free)

Please select a minimum of 1 subject and a maximum of 6 subjects

Other Subjects

Boarding OptionBoarding Fee: R1850 p/m
(Please Note: All fees must be paid in full by the 3rd day of the second last month of the contract in order to receive your examination time table)

Person Responsible for the Account

Account Payer - Full Names *

Account Payer - Title *

Account Payer - Cell No *

Account Payer - Spouse Cell No *

Account Payer - Occupation *

Account Payer - Fax

Account Payer - Residential Address *

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Details of the next of kin of the account payer

Next of Kin - Name and Surname *

Next of Kin - Relationship to Student *

Student Portal Sign Up

Account Payer - Surname *

Account Payer - ID Number *

Account Payer - Tel No (W) *

Account Payer - Email Address *

Account Payer - Company of Occupation *

Account Payer - Marital Status *

Account Payer - Postal Address *

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Next of Kin - ID Number *

Next of Kin - Cell No *

Email Address * Use an email address which you have access to, as we will be using this to communicate with you to complete the registration process.

Confirm Email Address *

Create a Password * Please create a memorable password which would be used to log into your student portal

Confirm Password *