Cinta Bahasa Registration Form
Register / Sign-up / Enroll
Registration does not mean you have to take a course,
it’s just so we know more about you.

Instructions
Step 1. Fill out this form in as much detail as possible and click on “SAVE”.
Step 2. We will review respond as soon as we can, usually within 12 hours.
If we have not responded quickly enough, please contact us at learn@cintabahasa.com
or call us at +62 812 3916 5005.
Email address *
Your First Name: *
Your answer
Your Last Name: *
Your answer
Your Email Address, Again Please: *
Your answer
Your Mobile Number:
Your answer
Your Date of Birth:
Your answer
Your Nationality:
Your answer
Where Would You Like to Learn With Us?
What Kind of Course Would You Like?
For Beginner Group, What Month Would You Like to Learn?
Your answer
For Private Course, What Date Would You Like To Start?
Your answer
For Private Course, What is Your Preferred Time of Day?
For Private Course, How Many Hours Would You Like to Book?
For Group and Private Courses, How Would You Prefer to Pay For Your Course? *
Why Would You Like to Learn Indonesian Language?
Your answer
Did Someone Refer You to Us? Would you tell us their name so that we can thank them?
Your answer
How Did You Find Out About Us?
Do You Have a Question You'd Like to Ask?
Your answer
A copy of your responses will be emailed to the address you provided.
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