Salam Pencak Silat. This is online registration for PERSILAT Virtual International Pencak Silat Championship 2021 Senior GANDA and TUNGGAL Category. Please fill the following form and submit.
Contact: Pak Arko Murjoko (+62-813-1471-1766), Ibu Titih Hayati (+62-813-2190-0948), Pak Iskandar (+62-813-1653-2160)
Email address *
Your full name *
Your mobile phone number *
Your country
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Name of National Federation/Association *
Annual 2021 Membership Fee of National Federation has been paid. *
Your title at National Federation/Association *
Full Name Athlete 1 GANDA MALE
Date Of Birth Athlete 1 GANDA MALE
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Full Name Athlete 2 GANDA MALE
Date Of Birth Athlete 2 GANDA MALE
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Description of GANDA MALE
Full Name Athlete 1 GANDA FEMALE
Date Of Birth Athlete 1 GANDA FEMALE
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Full Name Athlete 2 GANDA FEMALE
Date Of Birth Athlete 2 GANDA FEMALE
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Description of GANDA FEMALE
Full Name Athlete TUNGGAL MALE
Date Of Birth Athlete TUNGGAL MALE
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Full Name Athlete TUNGGAL FEMALE
Date Of Birth Athlete TUNGGAL FEMALE
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I UNDERSTAND THAT NEW RULES 2020 WILL BE USED IN THE CHAMPIONSHIP *
I AGREE THAT ATHLETES & COACH MUST AND WILL FOLLOW HEALTH PROTOCOL COVID-19 *
List name of IRJ who did NOT attend August/October 2020 Webinar and will attend 7-8 March 2021 virtual refreshing Referee-Jury. Fee of US$20 per person will be paid through PayPal at PERSILAT website or money transfer to Bank Negara Indonesia.
List name of IRJ who attended August/October 2020 Webinar and will attend 7-8 March 2021 virtual refreshing Referee-Jury for free of charge.
List name of IRJ attended August/October 2020 Webinar, already paid, already submitted the IRJ certificate, but still not received Webinar's Certificate.
List name of attendants non-IRJ of August/October 2020 Webinar, already paid, but still not received Webinar's Certificate.
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