« Back to main Indonesian Language Class page 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 (intermediate youth & adults) Full Name Gender ---FemaleMale Birth Date (yyyy-mm-dd) Place of Birth (city, country) Occupation (optional) Email Address Home Address Home Phone Cell Phone Enrolling for: ---Beginner level classIntermediate level class 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? ---YesNo 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: ---PaypalCredit CardDebit CardCheck 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: firstname.lastname@example.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.