Class: Jakarta Registration: Class in JakartaA. PERSONAL DETAILSMr.Mrs.Ms.Full Name:*Place of Birth:*Birth date: (Tahun/Bulan/Tanggal)*Country / Nationality: Please select ..... 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(NOTE: For Former Students ONLY)Wisma Bahasa YogyakartaWisma Bahasa JakartaWisma Bahasa BaliE-Learning/OnlineImmersionB. INDONESIAN 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 language:NoneBeginner/SurvivalIntermediateAdvancedExplain your proficiency:Emphasis: SpeakingListeningReadingWritingSpecial requests related to your interests:Expected result upon the completion of the training:Course Start Date:*Course End Date: Preferred Days:MondaySession 1Session 2Session 3Session 4 Session 5TuesdaySession 1Session 2Session 3Session 4 Session 5WednesdaySession 1Session 2Session 3Session 4 Session 5ThursdaySession 1Session 2Session 3Session 4 Session 5FridaySession 1Session 2Session 3Session 4 Session 5SaturdaySession 1Session 2NOTE: Session 1: 08.00 - 09.30; Session 2: 10.30 - 12.00; Session 3: 13.00 - 14.30; Session 4: 15.00 - 16.30; Session 5: 17.30 - 19.00. Each session: 90 minutes.C. OTHERHow did you know Wisma Bahasa:Wisma Bahasa Website Friend(s)My OrganizationFormer StudentOnline AdvertisingFacebookTwitterInstagramGoogle Brochuresor OtherPlease tell us how if you chose Other:D. PAYMENTMethods of payment:Transfer (Personal Account)Transfer (Company / Organisation Account)Wisma Bahasa PayPalCashCredit Cards Payment Link (Preferred)Payment AccountPersonalCompany/Organization AccountIf it is a company/organization account, please write the contact name and email:NOTE:Wisma Bahasa bank acc.: No. AC. 026 1978 141 - Swift code: BNINIDJAYGY - PT. Bank Negara Indonesia, Jl. Adisucipto No. 137, Yogyakarta.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 requestedE. TERMS AND CONDITIONS1. For personal account student, payment should be made in advance. This regulation is also applied for re-buying student. Wisma Bahasa will automatically suspend the lesson if payment is not yet 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 remittance.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%.F. SUBMITBy clicking on "Submit" below, you are agreeing to the terms and conditions above.Send a copy to your emailVISITOR VERIFICATION:I'm not a robot