CARD OF CONFIRMATION

Name of Participant:
Gender
:
Nationality
:
University
:
Major
:
Grade / Year
:
Email Address
:
(At least one)

Expected Duration of Stay

Arrival: Date :
Time :
Flight Number:
Departure: Date :
Time :
Flight Number:
Preferred Accommodation (please choose by marking X in the box):

Host family
Hotel (please refer to the attachment)
Would you prefer to stay with your friends who are also participants of this summer
course? If yes, please mention their name(s):
____________________________________________________
Arrangement is on first come first served basis. However, we will try our best to
accommodate you in your preferred choice.

Special Remarks:
Allergy

Yes, please specify:

No
Special diet (e.g. vegetarian)
Yes, please specify:
No
Medical insurance coverage:
Yes
Special medical needs or illness:
Yes, please specify:

No
Smoker:

Yes

No

No

 Other Special Remark:

_____________________________________________________________
_____________________________________________________________
Emergency contact:
Person to contact:
Relationship to participant:
Telephone number or any other alternative contact:
________________________________________
Feedback:
What do you wish to learn and gain from this summer course?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
What are your suggestion(s) for us to improve our summer course and help
make it an enjoyable experience?
_______________________________________________________________________
_______________________________________________________________________
__

Liaison officer-in-charge
Name
:
Contact email
:
Contact number
:
Note:
1. This card must be fully completed and sent back to the above officer-in-charge as soon
as possible. You may choose to fill this up via computer or handwritten ie. you may fill
up and scan it back to us. The file that we receive should be in PDF form. If this is not
possible, alternately you may send it in Word form.
2. We recommend you to forward any future emails to your liaison officer and also to
inquiry_sumco@ymail.com & sky_blue16790@hotmail.com.
3. In conjunction to the opening of this summer course, a welcoming party will be held
on 11th July 2010 at 5.00pm (GMT+7). Participants have to be ready BY 4.00 pm. There
will also be a closing ceremony for all participants which will be held on the night of 23 rd
July 2010. We do hope that you can arrange your flight details to coincide with our
schedule.

4. Please prepare the following documents and send them to the corresponding email by
30th June 2010.
Passport scanned copy
Passport-sized photo scanned copy
Visa scanned copy (optional)
Proof of enrolment & letter of recommendation from the respective institution of
higher education
Attachment:
ACCOMMODATION ARRANGEMENT
MODE OF
ACCOMMODATION
HOST FAMILY

ROOM
TYPE
SINGLE
ROOM

GADJAH MADA
UNIVERSITY CLUB
HOTEL
(UC HOTEL)

STANDARD
DELUXE
(twinshared)

DELUXE
(twin-shared)

RATE
(included in course
fee)
(included in course
fee)

ADDITIONAL
RP 845,000 FOR 13
NIGHTS (approx.
65 Euros)

ADDITIONAL CHARGE FOR

EXTRA STAY
RP 145,000/person/day (approx.
12 Euros)

RP 210,000/person/day (approx.
17 Euros)

We provide 13 nights stay from 11th July until 23rd July 2010, check out on 24th July 2010.
YOU HAVE TO INFORM YOUR LIAISON OFFICER-IN-CHARGE IF YOU
WISH TO EXTEND YOUR STAY OR ARRIVE EARLIER AS SOON AS
POSSIBLE so that we are able to arrange your accommodation.
The hotel rate stated above is for two persons per room. If you would like to stay
one person per room, additional charges are at your own cost. Please contact your
liaison officer regarding this matter.

If you would like to stay in the Deluxe Room, please specify it.

You do not have to pay additional charges via bank transfer. You would have to
pay that upon arrival in Yogyakarta.
For further information regarding your accommodation, please visit our website at
www.summercoursegmu.org. We do look forward to your stay!
Thank you.