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REGISTRATION

First Period. Application will be opened on Monday 18th, 2016 and will be closed om February

Free

20th, 2016. Before you fill the form below, make sure that you have downloaded the CV
template HERE
(http://downloads.ziddu.com/download/25153814/Curriculum_Vitae_Participants_Name_.docx.html).

REGISTRATION

Also dont forget to send your ideas in an essay with the topic Village Industries along with the
reasons to participate in the programme, implementation methodology of their ideas, and
commitment to build Village Industries in their country. And Upload it on form below.

World Village Conference 2016


Preserving Culture for Sustainable Development in the Era of VillageIndustrialization Purwakarta, Indonesia, May 23 25, 2016

Full Name *
Prefix

Upload a Recent
Photo (MAX. 1MB) *

First Name

Last Name

ChooseFile Nofilechosen

Nickname *
-

Date of Birth
Day

Month

Year

Contact Address *
Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

PleaseSelect

Phone Number *
Area Code

Phone Number

Mobile *
Area Code

E-mail *

Phone Number

ex:myname@example.com

FAX
Area Code

Phone Number

Nationality *
Occupation *

(For Indonesian Participants)

ID Card Number
Type of ID Card

(KTP/ SIM/ Others)

(For Foreigners Participants)

Given Name(s) as on
passport

Passport No
-

Expiry date

(DD/MM/YY)

Day

Month

Year

Place of Issue

For Emergency Contact (Must be Filled)

Name *
Relationship *
-

Contact Number *
Area Code

E-mail

Phone Number

ex:myname@example.com

Address
Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

PleaseSelect

The main communicating language of World Village Conference 2016 Preserving


Culture for Sustainable Development in the Era of Village-Industrialization will be
delivered In English, please give your considered and honest response to the
following question (circle the answer) :

How is your English Speaking skill *


Very Good
Good
Fair
Weak

How is your understanding of written English *


Very Good
Good
Fair
Weak

Special Request

Meals
vegetarian
non vegetarian

Dietary Restriction
Allergies
Other Needs

150 Delegates 40 Countries


Will be tightly selected through selection programme. Delegate will have to send
their ideas in an essay with the topic Village Industries along with the reasons to
participate in the programme, implementation methodology of their ideas, and
commitment to build Village Industries in their country.

Upload Your Essay (PDF or DOC ) Maximum Upload 1MB. Your file name

WVC2016Applicant_Participants Name (i.e. WVC2016Applicant_Nadya Tarigan) *


ChooseFile Nofilechosen

Upload Your CV (DOC or DOCX ) Maximum Upload 1MB. Your file name Curriculum
Vitae-Participants Name (Curriculum Vitae-Nadya Tarigan) *

Max 1MB

ChooseFile Nofilechosen

Enter the message as


it's shown *

SubmitForm

World Village Conference


World Village Conference 2016 is an event to celebrate village ecosystem, packed with inspiring speakers, skill-building programme and a variety
of exciting opportunities. Village Enthusiasts from every field like major industries, stakeholders, government, NGO, young generations, diplomat

will collaborate to fulfill visitors needs.

LATEST NEWS
Contact Us
Registration (regis2.html)
About Us (index.html#about)

2015 World Village Conference

(https://www.facebook.com/worldvillageconference)
(https://www.twitter.com/WV_conference)