Class: Yogyakarta Registration: Class in YogyakartaA. PERSONAL DETAILSMr.Mrs.Ms.Full Name:*Place of Birth:*Birth date: (Tahun/Bulan/Tanggal)*Country / Nationality: Please select..... 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NOTE: Free Visa (Exemption Visa) and VoA (e-VoA) cannot be used to take short course/short training! We recommend using Social Cultural Visa for Training and Short Course Purpose sponsored by Wisma Bahasa.*E-Mail:(valid email required)Address in Yogyakarta*Permanent Address:*Telephone / Mobile Phone:*Organization: Please select below....Government OrganizationNGO (Non-Government Organization)CompanyUniversity/SchoolPersonalThe name of your organization/company/university/school:*Occupation*Education*Language Spoken*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 UnderstandingDiplomatResearch ProfessionalsUKBI PreparationTour GuideKids > 6 y.o.CustomizedCurrent 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 2Session 3SundaySession 1Session 2NOTE: Each session: 105 minutes.Session 1: 08.00 - 09.45; Session 2: 10.15 - 12.00; Session 3: 13.00 - 14.45; Session 4: 15.15 - 17.00; Session 5: 17.15 - 19.00.SUPPORT ACTIVITIES (OPTIONAL)Learning hours include fieldtrips?General/Cultural Fieldtrips:Yogyakarta City TourTraditional MarketSilver CenterKeraton/Sultan PalaceTaman Sari Water CastleKota Gede Ancient VillageMt./Mount Merapi Lava TourAffandi MuseumPrambanan Temple Borobudur TempleRatu Boko TempleKasongan Pottery VillageImogiri Nobel CemeteryUllen Sentalu Museumor Others: (Please mention): Specialization Fieldtrips (offered for intermediate or higher proficiency level): Experts or lecturersPolitical parties such as DPD PDIP, DPD Golkar, DPD Demokrat, etcLocal NGO / LSM such as Rifka Annisa, PKBI DIY, etc.University Studies CenterFinancial Institutionor Others: (Please mention): Learning hours include cultural programs? Batik PaintingJavanese DanceBalinese DanceSundanese DanceCooking NoC. OTHERAccommodation (we could reserve it)HotelHomestayGuest houseApartmentOtherPlease explain:Pick up service upon arrival:(please write down your arrival details)How did you know Wisma Bahasa:Wisma Bahasa Website My OrganizationOnline AdvertisingFormer StudentFriend(s)FacebookTwitterInstagramGoogle Brochures, or OtherPlease tell us how if you chose Other:D. PAYMENTMethods of payment:Transfer (by Personal Account)Transfer (by Organization/Company Account)CashCredit Cards Payment Link (RECOMMENDED)Wisma Bahasa PayPalPayment AccountPersonalCompany/Organization AccountIf it is a company/organization account, please write the contact name and email:NOTE: Bank Account WISMA BAHASA: 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 requested.E. TERM AND CONDITIONS1. In case the payment is made in US dollars, the money should be issued no earlier than year 2001.2. Cash and Credit Card payment is made from Monday to Friday during working hours, 8 AM to 4 PM.3. In case the payment is made by telegraphic transfer, please send us a copy of the remittance. 4. Class cancellation notification less than 24 hours before class commencement is subject to a 50% charge. WB gives the exception to those who are engaged in emergencies.5. Both student and Wisma Bahasa have the right to terminate the service agreement for any reason, including ceasing services already underway. If Wisma Bahasa ends its service provision, it will make a 100% refund on the remaining sessions. Wisma Bahasa does not offer reimbursement to the student if the student terminates the agreement, where service is deemed to have already been provided and is already underway for all intents and purposes. If after the payment in advance is made, the agreement is terminated by the student before the service is underway, there shall be a refund of 75% for the unused services. F. SUBMITSend a copy to your email:By clicking on "SUBMIT" below, you are agreeing to the terms and conditions above.VISITOR VERIFICATION:I'm not a robot