Registration Form golf

INA – Van Oord Golf Tournament 2015
Riverside Golf & Country Club, 23rd October 2015

YES, I will participate in the INA – Van Oord Golf Tournament 2015, on Friday 23
October 2015 at the Riverside Golf & Country Club.

(Please fill in as applicable)
Full Name

:

Title

:

Company

:

Handicap

:

Size of T-shirt

:

Tel/Mobile/Fax

:

Email

:

 I will bring as guest(s) :
Name

: ________________________________

Name

: ________________________________

Title

:________________________________

Title

:________________________________

Company

: ________________________________

Company

: ________________________________

Handicap

: ________________________________

Handicap

: ________________________________

Size of T-shirt

:________________________________

Size of T-shirt

:________________________________

Phone

: ________________________________

Phone

: ________________________________

Email

: ________________________________

Email

: ________________________________

Payment can be made in cash at the Tournament or settled in advance by transfer to:
PT BANK RABOBANK INTERNATIONAL INDONESIA
Jl. Plaza 89, Jl H. R Rasuna Said Kav. X-7 No. 6 Jakarta 12940 Indonesia.
Indonesian Netherlands Association. Swift Code: RABOIDJA.
Bank account number: 06.00.001371 (EUR); 06.00.001369 (IDR)
OR
BANK MANDIRI – KCP JKT GATOT SUBROTO
Jl, Ged. Menara Jamsostek Lt.1 Menara Utara, Indonesia
Indonesian Netherlands Association. Swift code: BMRIIDJA

Account No.: 070-00-0656490-5 (IDR)
(Please fax the registration and copy of your payment to (+62-21)5290-2178 or Scanned email to:
events@ina.or.id)