|
Print this form and fax to 021.766 7245 or 021.780 3258 |
|
|
Srikandi
|
|
| Nama Lengkap | |
| Tanggal Lahir | |
| Alamat Rumah |
|
| Tel / Fax / Hp | |
| E-mail/ homepages | |
| Pekerjaan | |
| Alamat Kantor | |
| Tel / Fax Kantor | |
| Nama Suami | |
| Nationality | |
| Nama Perusahaan/ Organisasi Suami | |
| Alamat Kantor Suami | |
| Tel / Fax Kantor | |
| Tahun Perkawinan | |
| Jumlah Anak | |
| Hobby |
|
It would be helpful if you could let us have some information about yourself.
| Are you: | ||
| Living in Indonesia? | yes/no | |
| Would you like to help us in any way? Please let us know what you could offer: | ||
| Teaching special skills | yes/no | |
| Publicity | yes/no | |
| Helping with seminar | yes/no | |
| Hands on work with the public | yes/no | |
| Organizing skills | yes/no | |
| Running the activities? | yes/no | |
| Anything else? …………………………………… | ||
Where did you hear about The Srikandi?