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REGISTRATION FORM – CAMBRIDGE ENGLISH

WORKSHOP
HOTEL CIPUTRA JAKARTA, 17 JULY 2017

Name of Institution: Lazuardi GIS Jakarta Junior High

Unit : X SD xX SMP X SMA X University


X

Others

Address : Jln. Margasatwa, No. 38, Jagakarsa, Jakarta.

1. Name : Agung Abu Arafat Aljabari


Designation : Teacher
Mobile Number : 08561331789
E-Mail Address : agunga4@gmail.com

2. Name : Ovnica Nitasari


Designation : Teacher
Mobile Number : 081288950548
E-Mail Address :ovnica@lazuardi-gis.net

Please fill in the registration form and send to us latest by 10th July 2017 to: Jelita
Kartika at jkartika@cambridge.org , or call 021-290 22 550 ext 101 to find out
more information.

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