Sixth IBR Conference On

REGISTRATION FORM BALI TOUR PROGRAM

Participant Information * 1st Participant 2nd Participant Title (Dr / Prof / Other) FULL Name Institution / University Postal Address Phone / Fax Email Address *) Please attached a copy of your passport along with this form

Other Related Information

Payment Details a b c D No. Details Price (Rupiah) Pax Sub Total 1 Bali Tour 4 Days 3 Nights (12 - 15 July 2012) Rp. 3,500,000 2 Bali Tour 5 Days 4 Nights (12 - 16 July 2012) Rp. 4,500,000 3 Airlines Ticket : Surabaya - Denpasar Bali (Price Estimation) Rp. 700,000 4 Airlines Ticket : Denpasar Bali – Surabaya (Price Estimation) Rp. 700,000

TOTAL PAYMENT (US$)

*) a = Tour Information | b = Price Information | c Number of Participant | d = b x c

Banking Details US$ Bank Account Rupiah Account Account Name: Nuri Herachwati Account Name: Nuri Herachwati Account No : 0173763511 Account No : 0173762686 Bank Name: BNI Bank Name: BNI Bank Address: Bank Address: Universitas Airlangga, Surabaya, Indonesia Universitas Airlangga, Surabaya, Indonesia Swift Code: BNINIDJASBY *) All banking transfer fee MUST BE PAID by participant.

Please send this form to Email [email protected]

Schedule of Bali Tour Program

Day 1 - Thursday 12 July 2012 (Departure for Bali Optional Tour) 0800 Start of the day 0800-0900 Breakfast at hotel 0900-0930 Check Out Hotel 0930-1030 Transport to Airport 1030-1100 Check In Flight to Bali 1100-1200 Flight to Bali (Tentatives – Local Bali Time) 1200-1230 Baggage Processing 1230-1300 Transport to Local Restaurant 1300-1400 Lunch @ Local Restaurant 1400-1500 Transport to hotel 1500-1530 Check In Hotel @ Kuta Beach Area 1530-1830 Free time at Kuta Beach Area (Enjoy the beautiful kuta sandy beach and view the Sunset) 1830-1900 Preparation for Welcome Dinner 1900-2100 Welcome Dinner & Barong Dance Show 2100 End of Today Program

Day 2 - Friday 13 July 2012 (Full Day Bali Tour) 0800 Start of the day 0800-0900 Breakfast at hotel: 0900-2000 Full Day Bali Tour  Bedugul (Temple @ Beautiful Lake)  Alas Kedaton (Forrest with Thousand of Monkeys)  Tanah Lot (Beautiful Sunset View)  Jimbaran (Buffet Dinner @ Beach) 2000-2100 Back to Hotel @ Kuta Beach Area 2100 Free Program

Day 3 - Saturday 14 July 2012 (Full Day Bali Tour Program) 0800 Start of the day 0800-0900 Breakfast at hotel 0900-2000 Full Day Bali Tour  Garuda Wisnu Kencana (Giant statue of Garuda Bird on the top of the hill)  Celuk (Home made Silver Handycraft Industry)  Galuh (Traditional Antique Balinese House with local Souvenir shop)  Kecak Dance Show (Spectacular Dance) 2000-2100 Back to Hotel @ Kuta Beach Area 2100 Free Program

Day 4 - Sunday 15 July 2012 (Free Time waiting for Flight Home, OR another Bali Full Day Tour) 0800 Start of the day 0800-0900 Breakfast at hotel 0900 Free Time waiting for flight home (Flight directly from Bali to each participant country, without going back to Surabaya again) -OR- 0900-1700 Full Day Bali Tour  Ubud (Balinese Traditional village view with Rice Field)  Panelokan – Kintamani (Bali favorite tourist destination)  Pura Tirta Empul - Tapak Siring (Temple with the Fountain)  Sukowati Art Market (Baliniese Traditional Souvenir Shop) 1700-1800 Back to Hotel @ Kuta Beach Area 1800 Free Program

Day 5 - Monday 16 July 2012 (Free Time at Bali waiting for Flight back to Home Country) 0800 Start of the day 0800-0900 Breakfast at hotel 0900 Free Time waiting for flight home (Flight directly from Bali to each participant country)