Class: Bali Registration: Indonesian Class in BaliA. PERSONAL DETAILSMr.Mrs.Ms.Full Name(required)Birth Date: (Tahun/Bulan/Tanggal)(required)Country / Nationality: Please select..... Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (DRC) Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland FrenchFrench Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe(required)Passport #:(required)Permanent Addr.:(required)Email Addr.:(valid email required)Phone / Mobile # :(required)Organization: Please select below......Government OrganizationNGO (Non-Government Organization)CompanyUniversity/SchoolPersonal(required)The name of your organization/company/university/school:Occupation:(required)Education:(required)Language Spoken:(required)Address for Class:(required)Former/New Student:New StudentFormer Student:If you were a Former Student, where did you study at Wisma Bahasa? (NOTE: For Former Students ONLY)Wisma Bahasa YogyakartaWisma Bahasa JakartaWisma Bahasa BaliE-Learning/OnlineImmersionB. LANGUAGE PROGRAMLanguage chosen:IndonesianJavaneseSundaneseSelected Program bahasa Indonesia for (if you choose Indonesian):General Purposes (GILT) Intercultural UnderstandingDiplomatResearchProfessionalUKBI PreparationKids >6 y.o.Tour GuideCustomizedCurrent proficiency of the bahasa Indonesia:NoneBasic / SurvivalIntermediateAdvancedExplain your proficiency:Emphasis:SpeakingReadingListeningWritingSpecial requests related to your interests:Expected result upon the completion of the training:Course start date: (Tahun/Bulan/Tanggal)(required)Course end date: (Tahun/Bulan/Tanggal)Preferred days:MondaySession 1Session 2Session 3Session 4 TuesdaySession 1Session 2Session 3Session 4 WednesdaySession 1Session 2Session 3Session 4 ThursdaySession 1Session 2Session 3Session 4 FridaySession 1Session 2Session 3Session 4 SaturdaySession 1Session 2Session 3Session 4 NOTE: Session 1: 08.00 - 09.30; Session 2: 10.30 - 12.00; Session 3: 13.00 - 14.30; Session 4: 15.00 - 16.30; Each session: 90 minutes.C. PAYMENTMethods of payment:Transfer (Personal Acc.)Transfer (Company/Organization Acc.)Credit Cards CashWisma Bahasa PayPalPayment Link (Preferred)Payment AccountPersonalCompany/Organization AccountIf it is a company/organization account, please write the contact name and email:Bank Account: WISMA BAHASA No. AC. 026 1978 141 Swift code: BNINIDJAYGY . PT. Bank Negara Indonesia, Jl. Adisucipto No. 137, Yogyakarta. Please send us a copy of the telegraphic transfer. Payment link is the simplest way to make payments by Credit Card (Visa, Mastercard, etc.). You just click on the payment link that we sent to email, WhatsApp, SMS, etc. as your requested.Address to send an invoice (when payment is done by company or organization)D. OTHERSHow did you know Wisma Bahasa:Wisma Bahasa Website Friend(s)My OrganizationFormer StudentOnline AdvertisingFacebookTwitterInstagramGoogle Brochuresor OtherPlease tell us how, if you chose Other:E. TERMS AND CONDITIONS1.For personal account, payment should be made in advance. This regulation is also applied for re-buying student. Wisma Bahasa will automatically suspend the lessons if payment is not been received. 2. The payment should be transferred in full payment.3. In case the payment is made by telegraphic transfer, please send us a copy of the telegraphic transfer.4. Any class cancellation shall be notified no later than 1 working day prior to class commencement. Otherwise, one is subject to 50% of charge.5. To indicate the presence in the class, every student is to affix their signature on the attendance list we have prepared every time they attend the class.6. At the beginning of the first meeting, the teacher will provide short briefing to his/her students about the schedule, syllabus, and class terms and conditions.7. Both the student and Wisma Bahasa have the right to terminate any Services Agreement for any reason of whatsoever, including putting the services that are already underway to an end. No refunds shall be offered, where a service is deemed to have taken place and is, for all intents and purposes, underway. Any monies that have been paid to us which constitute payment in respect of the provision of unused services, will be refunded 75%.VISITOR VERIFICATION:I'm not a robotSUBMITBy submitting this form you agree to the terms and conditions above