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Ijen Festival Registration Form

Full Name Nick Name Place & Date of Birth Sex Nationality Passport / ID Number Address Phone Number Education Job E-mail address Facebook Account Twitter Account Fantastic Experiences

:DESI RIANA SAPUTRI............... : DESI... : PALEMBANG, DECEMBER 25th 1991. : FEMALE. : INDONESIAN... : 09/289033/PA/12897... : SURYOPRANOTO STREET NO 68 YOGYAKARTA : 085269696669......... : COLLEGIAN IN GADJAH MADA UNIVERSITY.... : -.............. : Desi_riana25@yahoo.com...... : Desi Riana Saputri........... : Desi_riana25......... : WHEN I JOIN the new BUSSINESS about BUBBLE BEE ....... : .

Where did you get the information From a. From my Friends

What make you deserve to join this Festival : I really want to join it because I want to study about Bondowosos culture, its traditional foods and also the attend the carnival. The festival is an international event so I want to promote about our country for another foreign people and make a good friendship with them.

*Please enclose the best picture of your traveling trip (1)

Ijenteam 2012 | www.ijenfestival.com

Please resend this registration to ijenfestival@gmail.com before May 12 2012

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