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Batam Indonesia Indah Puri Resort Golf Package

PERSONAL INFORMATION (Required Fields)* Full Name:* Mr. Mrs. Ms. Mdm. Dr. Nationality:* Email Address:* (Correspondence E-mail address) Email Address: (Second E-mail address,if any) Contact No:* Departure date:* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2011 2012 Number of passengers (Adult):* 1 2 3 4 5 6 Number of passengers (Child): NA 1 2 3 4 5 6 Inquiry:*

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