REGISTRATION

Register and payment will be closes on 1st April 2017
Limited Participant – only 20 person

Biaya pendaftaran (Entry Fee)  Komodo Audax:
Sekamar Sendiri (Single Room)  Rp. 17.250.000
Sekamar Berdua (Share Room)   Rp. 15.000.000

BANK ACCOUNT:

Transfer PAYPAL Entry Fee + Paypal Fee)
Account : balicycling@yahoo.co.uk

or

Bank Central Asia (KCU Kuta)   
Jl. Raya Kuta No. 55X Denpasar Bali 80361, Indonesia
Name : I Wayan Kertayasa
No. Rekening/Account number : 1 4 6 1 7 0 1 5 7 0
Swift Code : CENAIDJA

Include:  Komodo Audax program from 1 to 8 May 2016, room hotel ( click here )   breakfast, lunch, 1 piece  jersey, dinner, entry fee Kelimutu Lake and Komodo Island Tour, water / refreshment and support car.

Title (required)

Your Name (required)

Your Email (required)

No. KTP / Pasport /Foreigner with Passport Copy(required)

Telephone(required)

Address

City

Zip Code

Nationality

Sex (required)

Date of birth (D/M/Y) (required)

Room (required)

Jersey Size (required)

Own Insurance by (not required)

Insurance No (not required)

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