Bali Tech & Culture Immersion 2026

Welcome to the registration portal! This program includes 2 weeks online (July 6-17) and 1 week offline in Bali (July 19-25). Please complete all sections carefully.

1 Personal Information

Full Name (as in Passport) *

Gender *

Date of Birth *

Nationality *

Passport Number *

Must be valid through Dec 2026

Passport Expiry Date *

2 Contact Information

Email Address *

Please enter a valid email address.

Phone Number *

WhatsApp Number *

Primary communication channel

Current Address *

3 Institutional Information

Name of University/Institution *

Country of Institution *

Department/Faculty *

University Address *

Major/Field of Study *

Year of Study *

4 Program Requirements

Recommendation Letter *

Official letter from your institution. Must be on letterhead, signed, and dated.

Max: 5MB (PDF, JPG, PNG)

Passport Copy *

Clear copy of the photo page.

Max: 5MB (PDF, JPG, PNG)

5 Program Interest & Background

Primary Field of Interest (Select up to 2) *

Artificial Intelligence (AI) AR / VR Digital Creative Arts Cultural Heritage Balinese Philosophy Cultural Arts (Dance/Gamelan) Community Collaboration

What do you hope to gain? (150-300 words) *

Relevant Experience/Skills *

Dietary Requirements *

No restrictions Vegetarian Vegan Halal Gluten-free

Medical Conditions / Allergies *

Accessibility Requirements (Optional)

6 Registration Period & Payment

Registration Period *

Early Bird Jan 12 - Feb 28, 2026

Regular Mar 2 - Apr 28, 2026

Total Program Fee

--- IDR

Payment Date *

Transaction Ref Number *

Payment Method *

Payment Proof Upload *

Include "Bali Tech Camp" in description

7 Travel Information

Do you need a visa invitation letter? *

Yes No Not Sure

Planned Arrival in Bali *

Should be on/before July 18, 2026

Planned Departure *

Should be on/after July 26, 2026

Do you require airport pickup? *

Yes (Ngurah Rai International Airport) No, I will arrange my own transport

Flight Details (Optional)

Travel Insurance Information *

8 Emergency Contact

Contact Name *

Relationship *

Contact Phone *

Contact Email *

Please enter a valid email address.

9 Additional Information

How did you hear about this program?

T-shirt Size *

XS S M L XL XXL

Balinese Culture Experience (Optional)

Additional Comments/Questions (Optional)

10 Agreements

I confirm all information provided is accurate and complete.

Program Understanding:

I understand transportation is provided only during scheduled activities. I understand hotel accommodation is included (single/double occupancy). I understand visa fees, flights, and travel insurance are NOT included.

Releases:

I authorize emergency medical treatment if needed. I grant permission for photos/videos to be used for program promotion.

I have read and agree to the full terms and conditions.