Study Bahasa Indonesia in Bali

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Registration Form

Please fill out the following form to register on-line for the Study Bahasa Indonesia in Bali program. See also Group Study Tours

Personal Details:
Family Name
Given Name
Email
Date of Birth (dd/mm/yyyy)
Sex	M F
Citizenship
Passport No.
Address
Telephone
Fax
Occupation

Course Details:
I would like to enroll for:	Indonesian Language only (40 hours) Indonesian Language (40 hours) + Cultural Studies (20 hours)
Dates (tick preferred dates)	1 - 12 Oct 2007 7 - 19 January 2008 14 - 25 April 2008 7 - 18 July 2008 6 - 17 October 2008 5 - 16 January 2009

Homestay:
I require homestay accommodation.	Yes No
Do you have any medical problems?	Yes No
If yes, please specify:
Do you have special dietary requirements?	Yes No
If yes, please specify:

Indonesian Language:
Have you studied Indonesian before?	Yes No
If yes, please give information:
Please indicate your assessment of your Indonesian language ability:	Beginner Elementary Pre-Intermediate Intermediate Upper-Intermediate Advanced
What is your reason for studying Indonesian?
How did you hear about “Study Bahasa Indonesia in Bali?”

Payment:

I would like to pay on arrival
I would like to pay now

What to pay

Please indicate as appropriate:
Language A$ 590
Cultural Studies A$ 250
Homestay A$ 280

Total Payment

Payment Method

Direct transfer in rupiah* to:

Account Name	IALF
Account Number	789-30-00232-6 (Rupiah)
Bank	Lippobank
Bank Address	Jalan MH Thamrin Denpasar, Bali

*Please do not pay in a foreign currency.

If you wish to pay by credit card, please fax the following details to (62-361) 263-509:

Cardholders name:
Card number:
Type of card (Visa, Mastercard, Amex):
Expiry Date:

Please sign and date the fax.

Arrival Details:
Arrival Date/Time
Flight No.
Flight From

Thank you. We look forward to welcoming you to Bali.

Click submit below, and your registration will be sent to IALF.

Thank you. We look forward to welcoming you to Bali.

IALF Bali
Jalan Raya Sesetan 190
Denpasar 80232
Bali, Indonesia
Tel: +62 (361) 225243
Fax: +62 (361) 263509
Email: ils@ialf.edu

IALF Jakarta
Sentra Mulia Building, Ground Floor
Jl Rasuna Said Kav X-6 No. 8
Jakarta 12940
Tel. (62-21) 521-3350
Fax (62-21) 521-3349
ialfjkt@ialf.edu

IALF Surabaya
Jl Sumatera 49
Surabaya 60281
East Java
Tel. (62-31) 502-6400
Fax (62-31) 502-6408
ialfsby@ialf.edu

IALF Bali
Jl Raya Sesetan 190
Denpasar
Bali 80223
Tel. (62-361) 225-243
Fax (62-361) 263-509
ialfbali@ialf.edu

Locations

Jakarta Surabaya
Bali

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Study Bahasa Indonesia in Bali

Registration Form

Personal Details:

Course Details:

Homestay:

Indonesian Language:

Payment:

Arrival Details: