LES Village Coral Farm "Adopt the Coral Program"

Registration Form

Dear Our value Coral Adopter,

On behalf of LES Village Mina Bhakti Soansari Group of Fisherman, I would like to express our sincere appreciation of your contribution to our Adopt the Coral Project. Your valuable support will assist us to manage our conserve this coral habitat. We hope that you will be able to visit us here at Les Village in the future and see how your contribution has allowed us to maintain our lively hood while conserving the reefs for all our children.

Yours Sincerely,

I Made Merta
(Chairman of Les Village Mina Bhakti Soansari Fisherman Group)

all fields are required
Name to be put on Coral	:
Name of Adopter	:
Mailing Address	:
Street	:
City	:
Country	:
Phone / Fax no.	:
Email	:
Number of Coral(s) to adopt	:
Certified Diver	:	Yes No
Level of Certification	:
Annual Maintenance	:	Yes No
Printing (image size that you want to get via email)	:	Printing Size Small Size

Endorsed by:

Mina Bhakti Soansari Group,
Air Diving Academy
PT. Bahtera Lestari, LES Community Owned Company
Bahtera Nusantara Foundation
Marine Aquarium Council (MAC)

	Email

	Name


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