.:KORINDO 2010:.

ATTENDANCE REGISTRATION


Your Name
Title Salutation
Given Name Middle Name Family Name

Affiliation
Job Title
Section and Department
Organization
Nationality
Address
ZIP
Country
Telephone
Fax
E-mail Address
Attendance

Hotel Reservation
Name of Hotel *)
Your Check-in Date
Your Check-out Date
		Total days :
*) you may reserve another hotel listed above

Your Travel Schedule
<Incoming Flight> Date of Arrival	:
From	:	Flt.#
To	:	Flt.#
<Outgoing Flight> Date of Departure	:
From	:	Flt.#
To	:	Flt.#
Visa Application
Do you need visa to enter Indonesia?
Passport No.:
Date of Issue
Date of Expiry



LAPAN will support your visa application necessary to enter Indonesia, therefore, please contact the following PoCs of LAPAN at your earliest convenient time along with your scanned copy of passport as well to kerjasama_lapan@yahoo.com

LAPAN’s Persons of Contact: 1. Ms. Rosaliza Mobile : +628161386900 Tel : +62-21-4892802 ext. 118 Fax : +62-21+4788272726 Email : pukasi.lapan@gmail.com pukasi@lapan.go.id 2. Mr. Leo Kamilus Rijadi Mobile : +628161310486 Tel : +62-21-4892802 ext. 104 Fax : +62-21+4788272726 Email : kerjasama_lapan@yahoo.com leorijadi@yahoo.com hmsmagan@lapan.go.id

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