Bina Nusantara Programming Contest for High School Students 2008

Registration Form


Login Information
Username*	:	(Maks 10 character) Username Required Username has already exist
Password*	:	(Maks 6 character) Password Required
Re-enter password*	:	Re-enter your password Check your Password!
Personal Information
Full Name * (this will be printed in the Certificate)	:	enter your name
Place of Birth *	:	enter place of birth
Date of Birth*	:	enter date of birth
Address*	:	enter the Address
City*	:	enter your city
Province*	:	enter your province
Post Code*	:
Phone Number*	:	Phone Number required
Cell Phone Number	:	Must be number
Email*	:	Not an Email Format Your contact email Required
School Information
School Name*	:	University Name Required
Address*	:	University address Required
City*	:	University City Required
Province*	:	University Province Required
Phone	:
Fax	:
Area of study / Graduation Year *	:	enter one of the data
Bank Information
Bank Account*	:	Bank Account Required Must be number
Bank Name*	:	Bank Name Required


couldn't create account
* Required