1st Multisectoral Collaboration Seminar on Aspiration, Empowerment & Regional Innovation of Gorontalo’s Women for Future Sustainability of Traditional Karawo Ikat Embroidery

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Full name (Nama Lengkap) *

Gender (Jenis Kelamin) *

Male

Female

Age (Umur) *

Your origin (City/ Town/ Village name) Asal: ( Kota/ Kecamatan/ Desa) *

Occupation (Pekerjaan) *

Housewife (Ibu Rumah Tangga)

Farmer (Petani)

Civil Servant / Government Employee (Pegawai Negeri)

Business Owner (Pemilik Usaha)

Buying and Selling goods (Pedagang)

Karawo Shop Owner (Pemilik toko Karawo)

Karawo Maker (Pengerajin Karawo)

Company Employee (Pegawai Perusahaan)

Student (Pelajar)

Teacher/ Lecturer (Guru/ Dosen)

Cloth Washer (Tukang Cuci) [ Working at mining Site (Bekerja di lokasi tambang) * ]

Cooking (Tukang Masak) [ Working at mining Site (Bekerja di lokasi tambang) * ]

Miner (Penambang) [ Working at mining Site (Bekerja di lokasi tambang) * ]

Unemployed (Penganggur)

Your Organization
..............
Organisasi (Jika anda bekerja sebagai pegawai pemerintah atau perusahaan)

How many of your family member(s) are working in ASGM?
..............
Berapa banyak keluaga anda yang terlibat dalam pertambangan emas skala kecil (PESK)?)
*

No (Tidak)

More than 5

Are you currently living (near / close ) to the ASGM site?
..............
Apakah Anda saat ini tinggal (dekat / dekat) dengan lokasi PESK? *

Yes (Ya)

No (Tidak)

Email Address (Alamat Email)
.
We will send you a digital certificate, therefore please fill email in order to get your certificate.
..............
Kami akan mengirimkan sertifikat digital kepada Anda, oleh karena itu silakan isi email untuk mendapatkan sertifikat Anda. *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms