Student Name

Student Email

Mobile_phone

Parent Name

Parent Email

Parent_mobile_phone

City of Residence

Current/Latest School Name

Current/Latest Education Level

Primary

Junior High School

Senior High School

Certificate/Diploma

Undergraduate/Bachelor/S1

Graduate/Master/S2

Doctorate/S3

Other

Intended Start Date

Select... 2026 2027 2028 2029 Other

Study Program of Interest

Agriculture Architecture Arts/Design Biological/Biomedical Business Communication Computer/IT Education Engineering Hospitality Mathematics/Statistics Physical Sciences Psychology Social Sciences Other

How do you know about the event?

Embassy of Canada School Education Agent Recommendation (Friend/Family) WA/SMS E-mail Newspaper/Magazine Flyer/Poster Banner/Billboard Website Social Media (Facebook/Twitter/Instagram) Other

Which city do you want to register & attend?

Select... Bandung - Tue, 28 Oct 2025, Hilton Medan - Sun, 2 Nov 2025, JW Marriott

Preferred time to attend (Bandung)

16.00 - 17.00 WIB 17.00 - 18.00 WIB 18.00 - 19.00 WIB 19.00 - 20.00 WIB

Preferred time to attend (Medan)

14.00 - 15.00 WIB 15.00 - 16.00 WIB 16.00 - 17.00 WIB 17.00 - 18.00 WIB

I agree to receive communications from CEI-Indonesia

I agree to receive communications from the institution(s) that I visited/viewed during event