Choral Camp & Retreat 2018
12 - 14 January 2018 - Wisma Shalom - Lembang, Indonesia
Nama / Name *
Sesuai dengan yang akan tercantum di sertifikat / As to be stated on the certificate
Your answer
Jenis Kelamin / Gender *
Tanggal Lahir / Date of Birth *
Batas usia minimal 17 tahun, format: Bulan/Tanggal/Tahun | Minimum of age: 17 years. Format: MM/DD/YYYY
Your answer
No.HP / Mobile No. / WA *
Your answer
Alamat Surat / Postal Address *
Your answer
Kota / City *
Your answer
Negara / Country *
Your answer
E-mail *
E-mail aktif/Active E-mail
Your answer
Nama Gereja / Name of Church *
Your answer
E-mail Gereja / Church's E-mail *
Your answer
Nama PS / Name of Choir *
Your answer
E-mail PS / Choir's E-mail *
Your answer
Jabatan / Position *
Jabatan di dalam PS / Position in Choir
Required
Jenis Suara / Type of Voice *
Pemesanan Transportasi / Booking Transport *
Transportasi/Transportation: Bandung-Shalom & Shalom-Bandung
Tanggal Transfer / Date of Transfer *
MM
/
DD
/
YYYY
Jumlah Transfer / Amount of Transfer *
Your answer
Bank Asal / Bank of Origin *
Your answer
No. Rekening / Bank Account No. *
Your answer
Nama Pemilik Rekening / Account Holder *
Your answer
Berita Transfer / Purpose of Transfer *
Cantumkan: CCR18 [Nama Peserta] + Transportasi (jika ada) / Please mention: CCR18 [Participant's Name] + Transportation (if any)
Your answer
Pengiriman Bukti Transfer / Proof of Payment *
Sudah dikirimkan melalui / Has been sent via:
Perlu Penerjemah / Interpreter Needed *
Bisa membaca partitur / Able to read music: *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms