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Participant Fee

Category
Student
Public
Government
Industry
Package A

Category
Student
Public
Government
Industry

Package B

Category
Student
Public
Government
Industry
Package C

Category
Student
Public
Government
Industry

(Single Event)
Pre-Course

Workshop

IDR
500,000
500,000
500,000
500,000

IDR
250,000
750,000
750,000
1,500,000

Field Trip
Local
IDR
500,000
500,000
500,000
500,000

(Precourse, Workshop and Field Program)


Full package Field Trip
Local
Overseas
IDR
USD
1,000,000
315
1,500,000
415
1,500,000
415
2,250,000
790

Full Package Field Cam


Local
IDR
2,500,000
3,250,000
3,250,000
3,750,000

(Precourse and Field Program)


Full package Field Trip
Local
Overseas
IDR
USD
900,000
290
900,000
340
900,000
340
900,000
640

Full Package Field Cam


Local
IDR
2,400,000
2,400,000
2,400,000
2,400,000

(Workshop and Field Program)


Full package Field Trip
Local
Overseas
IDR
USD
650,000
265
1,150,000
315
1,150,000
315
1,900,000
390

Full Package Field Cam


Local
IDR
2,150,000
2,650,000
2,650,000
3,400,000

Field Trip
Overseas
USD
250
250
250
250

Package Field Camp


Overseas
USD
565
665
665
1,040

Package Field Camp


Overseas
USD
540
590
590
890

Package Field Camp


Overseas
USD
515
565
565
640

Field Camp
Local
Overseas
IDR
USD
2,000,000
500
2,000,000
500
2,000,000
500
2,000,000
500

EVENT REGISTRATION FORM


Personal Information
Name
Email address
Attendee category
Institution
Address

Mr.
name@email.com
Student
Institution name

Country
Phone Number

Indonesia
+62 888 8888 8888

Program
Pre course
Workshop
Include Field Program

Yes
Yes
Field Camp

Payment Method (Circle the preferred method)


* Please attach the payment proof to "Payment attachment" sheet
** Please bring the printout of this form at the registration booth

Pay via bank telegraphic transfer


O BNI-ITB Geothermal Workshop
Account Number : 024-3290-419
Pay directly to organizer
Fitri Oktaviani
Committee 4th ITB International Geothermal Workshop 2015
X
Prodi Teknik Panas Bumi, FTTM-ITB, Gedung Energi Lantai 2
Jl. Ganesha 10 Bandung, Indonesia
Phone : +62 878 2358-0348

* Only blue-colored cells can be edited

REGISTRATION FORM

Participant Name
@email.com
nt
tion name

esia
88 8888 8888

d method)

othermal Workshop 2015


Gedung Energi Lantai 2

Monday, March 16, 2015

Participant Name

Please attach the payment proof below

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