DISTRICT CONFERENCE 2007
ROTARY INTERNATIONAL
DISTRICT 3400
BANDUNG, MAY 4 – 5, 2007
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REGISTRATION FORM
DISTRICT CONFERENCE 2007

Name of Rotary Club : ………………..                              Date : ……………………….. 

 

No.

 

Complete Name

 

* Status in RC

 

 

PHF

Participate in Workshops

( A,B,C,D )

1

 

 

Yes

No

2

 

 

 

 

 

3

 

 

 

 

 

4

 

 

 

 

 

5

 

 

 

 

 

6

 

 

 

 

 

7

 

 

 

 

 

8

 

 

 

 

 

9

 

 

 

 

 

10

 

 

 

 

 

 

Notes :
   Status in RC :  (DG) District Governor; (PDG) Past DG, (DO) District Officer; (P) President; (IP) Incoming President; (PP) Past President ; (Sps) Spouse.  

Please send your registration to
    e-mail : [email protected]
     Telp./Fax. : 022-4203268

Transfer for Payment :
In Rp. ( IDR)
BCA  Juanda Bandung
ac  7770619585
 an Rizka Aula Assaf

In US $
HSBC Bandung, Indonesia
AC : 050 052 356 081
an Rizka Aula Assaf

Workshops :

A.      Health & Hunger

B.       Water & Waste management                        

C.       Literacy

D.      Family of Rotary   

For registration, please kindly  attach your receipt of payment
Changement should be made 7 days prior the event
No refund for cancellation 

REGISTRATION FEE         per person

 

Category

 

Early Birds

Deadline 1

15 March 2007

 

Deadline 2

15 April 2007

 

Deadline 3

On-site Registration

Rotarian

Rp.   450.000,-  $ 55.-

Rp.   500.000,-   $ 60.-

Rp.   550.000,-   $  65.-

Spouse

Rp.   350.000,-  $ 45.-

Rp.   400.000,-   $ 50.-

Rp.   450.000,-   $  55.-

Non-Rotarian

Rp.   450.000,-  $ 55.-

Rp.   500.000,-   $ 60.-

Rp.   550.000,-   $  65.-

Download Regristration Form|Lihat Pendaftar (See Participant)
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