Sekolah HighScope Indonesia

Jl. T.B. Simatupang No. 8 - Cilandak Barat Jakarta 12430

Tel: (021) 7591-7888, Fax: (021) 7591-7887
www.highscope.or.id

Participation Form – Movie Work Shop 2016

 School : __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ __ _ _ _ _ _ __ __ _ _ _ _ _ _ _
address : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ ____ _ _____ _ _ _ _ _ _ _
phone: _ _ _ _ _ _ _ _ _ _ _ fax : _ _ _ _ _ _ __ _ _ Website : _ _ _ _ _ _ _ __ _ _ _ email: __ _ _ _ _ _ _ _ _ _ _ _ _ _ _
 Principal : _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _
Phone: _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ Mobile: __ _ _ _ _ _ _ _ _ _ _ _ _ _ email: _ _ _ _ _ _ __ __ __ _ _ _ __ _ _ _ _ _
 PIC Movie Workshop 2016_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___position _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _
Phone: _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ Mobile: __ _ _ _ _ _ _ _ _ _ _ _ _ _ email: _ _ _ _ _ _ __ __ __ ____ ___ _ _ _ _

Participant
No team Name Grade Phone Email
1
2
3 Film Maker
4
5
6
7
Actors /
8
actress
9
10
11
12
Soundtrack
13
14

Agreed to participate in Movie Workshop 2016, with payment Rp 500.000/team

Signed by,

( ) date _________________ *with school stamp

Principal

Please make the payment by bank to: Yayasan Sekolah Belajar Aktif Indonesia 1996, A/C: 127-000-738-522-0, Bank
Mandiri Talavera or Yayasan Sekolah Belajar Aktif Indonesia 1996, A/C: 0443-010-0030-5305, BRI TB
Simatupang

Please send the registration form and the payment slip by fax to: (021) 7591-7887 or email hiffest@highscope.or.id UP:
Committee HiFFest 2016. Registration and payment we received no later than Wednesday, 9 November 2016. The fee for
cancelation of this event will be taken 30% out of the participation fee.

Note: required to submit the story idea /synopsis story to the committee.