(family) Name: Wiguna First (given) Name: Yedi Affiliation: Nationality: Indonesia Age: 23 Birthday (MM/DD/YY): 10 / 28 /1989 Passport No: A2536639 Planning to attend the forum on 11-12 May, 2013 11 May, 2013 12 May, 2013 Method of Transportation to Fukushima Train Airplane Flight, train number: Email Address: yedidos_upi@yahoo.co.id Permanent Address: Accommodation I would like to stay at Fukushima Youth Hall. I do not need accommodation. Motivation/Other requests: Bus Other (Specify) ____________