ImPermanence Production

Application Form PF

Application Form

Thank you for your interests and participation in Pelem Festival 2018.  

Please fill out the on-line application form below. 
If you have any questions, please do not hesitate to contact info@takashitakiguchi.com

PERSONAL INFORMATION
Your Name *
Your Name
Residential Address *
Residential Address
Mobile Phone (with country code) *
Mobile Phone (with country code)
Which app is the best for us to contact you in Indonesia *
1. Emergency Contact Person 2. Relationship 3. Contact number
ABOUT YOUR PRACTICE
(Not required if you are visiting audience)
http://
(Not required if you are visiting audience)
ARRIVAL INFORMATION
Date of Arrival: Time of Arrival: Flight No:
PICK UP ARRANGEMENT
We can organise a community Taxi from the airport OR from your hotel. It will take 3-4 hours from the Jokjakarta city. The bus costs between IDR80,000 to IDR85.000. Please pay to the driver directly. The booking is required 2 day prior to the travel date. The bus will drop you off at the "IndoMart Punung" and someone from SACPA will pick you up from the stop.
ACCOMO TYPE
See the Boarding Type at https://impermanenceproductions.com/fees-and-costs/
PERMISSION
I give permission for my photographs/videos to be used as promotional / publicity materials. *