Bahasa Indonesia Course

Application  Form for Youth & Adult (15yrs & up)

Class sessions: Saturdays / March 4, 2017 - April 8, 2017 (6 meeting sessions)

Time: 1.30pm - 3.30pm (beginner youth & adults) / 4pm - 6 pm (intermediate youth & adults)

 

Full Name

Gender

Birth Date (yyyy-mm-dd)

Place of Birth (city, country)

Occupation (optional)

Email Address

Home Address

Home Phone

Cell Phone

Enrolling for:

Medical/allergy Information

Other useful note about you, e.g. learning style, interests, etc. (optional)

Will your placement in our class be part of the Family Package?

If you choose 'Yes', please insert names of your other family members that will participate in our classes (max. 2 other family members to be included in the Family Package)

(Please separately register the other family members mentioned above once you are done with this registration)

How did you hear about this course? I.e.: from friends, FB, ICONE's website, twitter, other links, etc.

PAYMENT

Individual tuition fee: $180/student for 6 class sessions (1 1/2 months)

Also available, Family Package tuition fee:
1.$325/2 family members for 6 meeting sessions (1 1/2 months).
2.$475/3 family members for 6 meeting sessions (1 1/2 months).

Payment method:

If you choose payment by check, please mail check to:
Yana Regan / Indonesian Community of New England, Inc.
400 Washington St., Suite 408
Braintree, MA 02189

Payments for Family Package can be done by checks to the address stated above.
Checks must be received by us within 1 week of application submission.

For comments or questions, please email us at: contact@icone-inc.org

Please click the 'Submit' button below to confirm your registration. Once you click the button below, please wait for few seconds until the page for payment appears.

Thank you.