Public Lecture & Workshop AYSPP UGM 2017 - Proof of Payment
IMPORTANT NOTE: You need to pay IDR 50.000 commitment fee first before you can complete this registration form. The commitment fee will be reimbursed to you two weeks after the end of the workshop, on the condition that you attend all sessions of the Public Lecture and Workshop.

Transfer the commitment fee to the following account:
Bank Account Name: Nur Imania
Bank Name: Mandiri
Bank Branch: KCP Yogyakarta FISIPOL UGM 13705
Bank Account No.: 137-00-1217590-3

Your registration will be automatically invalid if you have not made the payment before you fill this form.

Commitment Fee Payment *
Your Bank Account used for payment or reimburse *
Your Bank Account Name used for payment or reimburse *
Your answer
Your Bank Account Number used for payment or reimburse *
Your answer
Reference Number (if any)
Your answer
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