Registration Registration A. Personal Details Full Name * Nationality Sex * MaleFemale Passport Number Present Addres Phone / Fax Email * Adress in Yogyakarta (if any) Company / Organization Occupation Education In Case Of Emergency First Person To Contact Is His or Her phone / fax * B. Term Of Payment Paid By IndividuallyOrganization Paid upon my arrival with CashCredit CardBank Transfer C. Visa We need your arrangement and sponsorship of an application for 6 month Social-Culture Visa or 1 year visa: NoYes, 1 year Student VisaYes, Social-Culture Visa for 6 months If so, from wich Indonesian embassy or consulate do you intend to get your visa (city/country): D. Language Program Approximate date of arrival Approximate date of starting the class Approximate date of completing the program Have you taken an Indonesian language training NoYes If so, how long ? Level to start at Puri Bahasa Indonesia BeginnerIntermediateAdvanced How many hours per day to learn Indonesian at Puri Bahasa Indonesia Prefered Schedule for your class 8 AM - 12 AM10 AM - 1 PM1 PM - 3 PM2 PM - 4 PM8 AM - 11 AM10 AM - 12 PM11 AM - 1 PM1 PM - 4 PM2 PM - 5 PMAny time Saturday Classes? YesNoDiscuss upon my arrival You may add the following classes within your learning hours: Borobudur Temple for 4 hoursPrambanan Temple For 4 hours:Traditional Market for 2 hours:Sultan Palace for 2 hours:Imogiri Royal Palace for 2 hours:Beaches for 4 hoursLive in a village for 4 hours E. Accomodation I plan to stay at Puri Guest HouseHomestayHotel all of categoriesLosmen (back packed travellerFriend's If you stay at Puri Guest House F. Others The purpose of learning Indonesian. Please, state in English: Special request for language training. Please, state in English: Cultural activities, excluding the learning hours : Batik Class for 2 hoursDancing class for 2 hoursCooking class for free of chargeRamayana BalletPractising Gamelan and watching feather Puppet ShowWood carving mask class ( 8 hours ) Please leave this field empty.