Plan Your Weddings Please tell us about your wedding in the form below. A property representative will contact you to discuss your needs. Your Requested Will Be Sent To: Cipta Hotel Pancoran * Fields marked are required. About You: Name:* Title:* Bride Groom 3rd Party Secondary Contact Name: Title 2: Bride Groom 3rd Party Email:* Mobile Phone:* Work Phone: Address 1: Address 2: City: Bandung Jakarta Semarang Surabaya Medan Makassar Balikpapan Palembang Pekanbaru Banjarmasin Batam Pontianak Solo Samarinda Padang Yogyakarta Malang Manado Denpasar Bandar Lampung State/Province: Aceh Sumatera Utara Sumatera Barat Riau Jambi Sumatera Selatan Bengkulu Lampung Kepulauan Bangka Belitung Kepulauan Riau Kalimantan Utara Dki Jakarta Jawa Barat Jawa Tengah Di Yogyakarta Jawa Timur Banten Bali Nusa Tenggara Barat Nusa Tenggara Timur Kalimantan Barat Kalimantan Tengah Kalimantan Selatan Kalimantan Timur Kalimantan Utara Sulawesi Utara Sulawesi Tengah Sulawesi Selatan Sulawesi Tenggara Gorontalo Sulawesi Barat Maluku Maluku Utara Papua Barat Papua Zip/Postal Code: Country: Pick Country Andorra United Arab Emirates Afghanistan Antigua and Barbuda Anguilla Albania Armenia Netherlands Antilles Angola Antarctica Argentina American Samoa Austria Australia Aruba Aland Islands Azerbaijan Bosnia and Herzegovina Barbados Bangladesh Belgium Burkina Faso Bulgaria Bahrain Burundi Benin Bermuda Brunei Bolivia Brazil Bahamas Bhutan Bouvet Island Botswana Belarus Belize Canada Cocos (Keeling) Islands Democratic Republic of Congo Central African Republic Congo Switzerland Ivory Coast Cook Islands Chile Cameroon China Colombia Costa Rica Cuba Cape Verde Christmas Island Cyprus Czech Republic Germany Djibouti Denmark Dominica Dominican Republic Algeria Ecuador Estonia Egypt Western Sahara Eritrea Spain Ethiopia Finland Fiji Falkland Islands Federated States of Micronesia Faroe Islands rance Gabon Grenada Georgia French Guyana Ghana Gibraltar Greenland Gambia Guinea Guadeloupe Equatorial Guinea Greece South Georgia and South Sandwich Islands Guatemala Guam Guinea-Bissau Guyana Hong Kong Heard Island and Mcdonald Islands Honduras Croatia Haiti Hungary Indonesia Ireland Israel India British Indian Ocean Territory Iraq Iran Iceland Italy Jamaica Jordan Japan Kenya Kyrgyzstan Cambodia Kiribati Comoros Saint Kitts and Nevis North Korea South Korea Kuwait Cayman Islands Kazakhstan Laos Lebanon Saint Lucia Liechtenstein Sri Lanka Liberia Lesotho Lithuania Luxembourg Latvia Libya Morocco Monaco Moldova Montenegro Madagascar Marshall Islands Macedonia Mali Myanmar Mongolia Macau Northern Mariana Islands Martinique Mauritania Montserrat Malta Mauritius Maldives Malawi Mexico Malaysia Mozambique Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua Netherlands Norway Nepal Nauru Niue New Zealand Oman Panama Peru French Polynesia Papua New Guinea Philippines Spratly Islands Pakistan Poland Saint Pierre and Miquelon Pitcairn Islands Puerto Rico Palestinian Occupied Territories Portugal Palau Paraguay Qatar Reunion Romania Serbia Russia Rwanda Saudi Arabia Solomon Islands Seychelles Sudan Sweden Singapore Saint Helena and Dependencies Slovenia Svalbard and Jan Mayen Slovakia Sierra Leone San Marino Senegal Somalia Suriname Sao Tome and Principe El Salvador Syria Swaziland Turks And Caicos Islands Chad French Southern Territories Togo Thailand Tajikistan Tokelau East Timor Turkmenistan Tunisia Tonga Turkey Trinidad and Tobago Tuvalu Taiwan Tanzania Ukraine Uganda United Kingdom United States Minor Outlying Islands United States Uruguay Uzbekistan Vatican City Saint Vincent and the Grenadines Venezuela British Virgin Islands US Virgin Islands Vietnam Vanuatu Wallis and Futuna Samoa United Nations Neutral Zone Iraq-Saudi Arabia Neutral Zone Disputed Territory Yemen Mayotte South Africa Zambia Zimbabwe About Your Day: Are you planning on hosting an event at the hotel ?: Yes No Anticipated Events: Wedding Ceremony Wedding Reception Honeymoon Desired Wedding Date:* Alternative Wedding Date: Wedding Time: Morning Afternoon Evening Number of Guests: Venue: The Dining Room Meeting Room Guest Accommodations: Will you require rooms for yourself or your guests?: Yes No Check In Date: Check Out Date: Number of Rooms: Comments: How did you hear about us?: Website Flyer Social Media Wedding Exhibition Family Friend Other Addition Information: