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.
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
or call us at +62 812 3916 5005.
Your First Name:
Your Last Name:
Your Email Address, Again Please:
Your Mobile Number:
Your Date of Birth:
Where Would You Like to Learn With Us?
Online from anywhere
What Kind of Course Would You Like?
2-Hour Crash Course
Beginner Group Course
Private Course (1 Student - 1 Teacher)
Private Course (2 Students - 1 Teacher)
Intensive Private Course - 4 hours per day
For Beginner Group, What Month Would You Like to Learn?
For Private Course, What Date Would You Like To Start?
For Private Course, What is Your Preferred Time of Day?
Evening between 5pm - 8pm
For Private Course, How Many Hours Would You Like to Book?
More than 60 Hours (Please email us with details)
For Group and Private Courses, How Would You Prefer to Pay For Your Course?
Local Bank Transfer in Indonesia only
Local Bank Transfer in Australia only
Paypal for all international transfers
Credit/Debit Card at our school in Ubud only
In Cash at our school in Ubud or Sanur
Why Would You Like to Learn Indonesian Language?
Did Someone Refer You to Us? Would you tell us their name so that we can thank them?
How Did You Find Out About Us?
Do You Have a Question You'd Like to Ask?
A copy of your responses will be emailed to the address you provided.
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