Jazz GirLi Registration Form
Sila mengisi formulir di bawah ini untuk mendaftar festival Jazz GirLi di bantaran sungai.

TENTANG JAZZ GIRLI
Jazz Pinggir Kali (Jazz GirLi), sebuah social movement berkaitan dengan keberlanjutan sungai dan bantarannya yang menggunakan musik (terutama jazz) sebagai kendaraannya. Salah satu event tahunan Jazz GirLi berupa festival jazz dalam format camping 3 hari 2 malam yang akan dilaksanakan di bantaran Sungai Tuntung Gunung, Desa Wisata Limbasari, Kecamatan Bobotsari, Kabupaten Purbalingga, Jawa Tengah pada tanggal 12-14 Mei 2017.

Rp 1.500.000,- / pax
Rp 5.500.000,- / 4 pax

Benefits:
1. Akomodasi tenda 2 malam
2. Exclusive Merchandise
3. Networking
4. VIP seat at Jazz GirLi Concert
5. Meet & Greet dg musisi
6. Workshop kit
7. Sertifikat
8. River tubing
9. Bibit bambu dan atau tanaman lainnya

Hal-hal di luar yang disebutkan di atas menjadi tanggung jawab peserta.

Metode pembayaran melalui transfer ke rekening berikut:

Bank BRI Britama
KCP Rawa Bambu

No. Rekening:
2009-01-004495-50-4

a.n.:
Irwan Fakhruddin


Pembayaran dilakukan max 2 hari setelah mengisi form pendaftaran.
Setelah melakukan pembayaran, harap mengisi form "Konfirmasi Pembayaran" di bit.ly/konfirmasijazzgirli

Pendaftaran peserta akan kami tutup pada tanggal 30 April 2017 pukul 23.59 WIB, atau sewaktu-waktu apabila kuota telah terpenuhi.

Contact Person
Chia 0811 155 250
Echa 0812 8458 9123

====================================================

Please enter your information below to register for our 3D2N jazz festival by the riverbank.

ABOUT JAZZ GIRLI
Jazz Pinggir Kali (Jazz GirLi) is a river revitalization movement that use music, especially jazz, as the vehicle. One of our annual event is a jazz festival by the riverbank. This event will be conducted in a 3D2N bootcamp format at the Tuntung Gunung Riverbank in Limbasari Village, Bobotsari Sub-district, Purbalingga Regency, Central Java, Indonesia on May 12-14, 2017.

IDR 1.500.000,- / pax
IDR 5.500.000,- / 4 pax

Benefits:
1. Accommodation (tent)
2. Exclusive Merchandise
3. Networking
4. VIP seat at Jazz GirLi Concert
5. Meet & Greet with the musicians
6. Workshop kit
7. Certificate
8. River tubing
9. Bamboo or other plant seeds

Things beyond those mentioned above are the responsibility of the participants.

Payment can be made via transfer to:

Bank BRI Britama
KCP Rawa Bambu

Account No.:
2009-01-004495-50-4

Account Holder:
Irwan Fakhruddin


The payment must be paid max 2 days after reservation. Your reservation will be secured upon payment confirmation on bit.ly/konfirmasijazzgirli

The registration will be closed by 30 April 2017 or when maximum capacity of attendance is fulfilled.

Contact Person
Chia 0811 155 250
Echa 0812 8458 9123
Full Name *
Nama Lengkap
Your answer
Nick Name *
Nama Panggilan
Your answer
Date of Birth *
Tanggal Lahir
MM
/
DD
/
YYYY
Email Address *
Alamat Email
Your answer
Phone Number *
No. Telp / HP / WA
Your answer
Where are you from? *
Kota Domisili
Your answer
Name of Your School/ University/ Organisation/ Community *
Nama Sekolah/ Universitas/ Organisasi/ Komunitas Anda
Your answer
Blood Type *
Golongan Darah
Allergies; Illness *
Alergi; Penyakit yang pernah diderita
Your answer
Agreement: I will always keep my mindset, behaviour, and act to be positive for the river, will do whatever it takes to protect for future living. *
Perjanjian: Saya akan selalu menjaga pola pikir (mindset), perilaku dan tindakan positif terhadap sungai. Saya akan melakukan yang terbaik untuk menjaga lingkungan demi masa depan kehidupan.
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