Indonesian Language Class Registration Form for Adults

Bahasa Indonesia Course

Registration Form

 

Class sessions: Saturdays / March 7 - April 18, 2020 (7 class sessions)

Times: 11am - 1pm (beginner) / 1.30pm - 3.30pm (intermediate)

Location: Pao Arts Center, Classroom 2, 99 Albany Street, Boston, MA 02111

Full Name

Gender

Birth Date (dd-mm-yyyy)

Place of Birth (city, country)

Occupation (optional)

Email Address

Home Address

Home Phone

Cell Phone

Enrolling for:

Are you a returning student?

If you choose 'Yes' on the above question, please insert which level and year you've joined the last Bahasa Indonesian course by ICONE.

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 & Friend Package?

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

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

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

PAYMENT

Individual donation: $200/new student for 7 class sessions or $190/returning student for 7 class sessions.

Also available, Family & Friend Package donation options:
1. $360/2 family members or friends for 7 class sessions
2. $510/3 family members or friends for 7 class sessions

Payment method:

If you choose payment by check, please mail the check to:
Trisia Bantacut / Indonesian Community of New England, Inc.
622 N Main St #1, Mansfield, MA 02048

Payment for the Family & Friend Package option 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 or dhanni.setyaning@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 payment page appears. The payment page can be used for any credit/debit card and PayPal payment methods. Payments via Venmo can be done separately through www.venmo.com/ICONE

Thank you.