Pengisian Data Peserta
Please fill the empty space below according to your ID Card (Passport if you are foreigner)
Nama Lengkap (Full Name) *
Your answer
Nama Panggilan (Preferred Name) *
We provide an ID Card for each of you to enter the conference. So preferred name will be needed
Your answer
Jenis Kelamin (Gender) *
Usia (Age) *
Your answer
Asal Negara (Country)
Your answer
Alamat Kota Domisili (Address) *
Your answer
Asal Kota / Provinsi (City/State) *
Your answer
Nomor Telepon / HP (Phone Number) *
Your answer
Gereja / ministry / institusi / pribadi (Church/ministry/organisation/personal) *
Which community do you come from or represent
Your answer
Status *
Sesi yang Anda Ikuti (Session that you'll join) *
Required
Tanggal Kedatangan di Yogyakarta (Arrival Date) *
MM
/
DD
/
YYYY
Jam Kedatangan di Yogyakarta (Arrival Time) *
Time
:
Tempat Kedatangan di Yogyakarta (Arrival Place) *
Akomodasi Selama Acara (Gathering Acomodation) *
Tanggal Kepulangan dari Yogyakarta (Departure Date) *
MM
/
DD
/
YYYY
Jam Kepulangan dari Yogyakarta (Departure Time) *
Time
:
Tempat Kepulangan dari Yogyakarta (Departure Place) *
Pembayaran Kontribusi (Payment) *
Rekening BCA a/n Rosi Dwi Jayani 7850717944
Pertanyaan Lain -lain (Other Questions)
Your answer
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