Indonesian Language Class Registration Form for Adults

Registration Form

10 sessions of live virtual classes via Zoom (link will be provided by the instructor).

Live sessions include speaking practice, writing exercise, and interactive quizzes to practice vocabulary and grammar.

Students are expected to spend about 20 to 30 minutes to view the pre-recorded lessons that will be sent prior to each session.

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 10 class sessions or $190/returning student for 10 class sessions.

Also available, Family & Friend Package donation options:
1. $360/2 family members or friends for 10 class sessions
2. $510/3 family members or friends for 10 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.

Payments via Venmo can be done separately through www.venmo.com/ICONE

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. This payment page can be used for any credit/debit card and PayPal payment methods.

Thank you.