Linimas(s)a Film Order Form

3 main content of the package you will received:

  1. 1 copies of original DVD Linimas(s)a + 2 more original copies (can be used as door prizes)
  2. 2 copies of Supplement CD, consists of: e-Book Internet Sehat, Parental Software, 10 Tactics video clips (InformationActivism.org), some e-Books for Blogger, Citizen Journalist & Information Activism.
  3. 2 copies of original CD Norton Internet Security 2010/2011 (can be used as door prizes)

-

(notes: Only for Jakarta area, the shipment will start on W1 May 2011. While for other cities, the shipment will start on W1 April 2011. Delivery process start from online form submission until the package delivered to the destination will take about 1-2 weeks)

-

3  ways to promote your screening:

  1. Embed the trailer video on your blog or website
  2. Download flyer (free to retouch / redesign) and distribute it online/offline (flyer size 5 Mb)
  3. For Indonesian, twit your agenda with #linimas(s)a hashtag and mention to us @internetsehat

-

-

Nama Penanggung Jawab / Person-in-Charge

Pekerjaan / Occupation

Nomor Telepon / Phone Number

Email

Alamat Pengiriman / Shipment Address

Kode Pos / Postal Code

Institusi Penyelenggara / Organizer Institution

Nama Kegiatan / Activity Title

Jenis Kegiatan / Activity Type
 informal seminar/workshop diskusi kelas/kampus - class/campus discussion

Deskripsi (kapan, dimana, peserta, dll) / Description (when, where, audience, etc)

Saya menyatakan bahwa isian data di atas adalah benar. Saya akan mematuhi semua aturan yang telah ditetapkan oleh pengelola Linimas(s)a.

I certify that the above data are correct. I will obey all the rules that have been set by Linimas(s)a manager.

captcha Masukkan kode ini / Input this code


Setelah klik 'send', tunggu sebentar dan kemudian periksa box di bawah ini untuk meyakinkan informasi telah berhasil dikirim.

After clicking 'send', wait a second and then check the box bellow to make sure information successfully submitted