Affiliate Application - Bali Takeover

Application

First Name

Last Name

Mobile Number

Instagram Name

Do you wish to attend alone or with friends?

Alone With Friends Not Sure

What month are you applying for?

Where are you travelling from?

You are applying to be part of a party group in Bali, Indonesia. By ticking this box you are confirming that you will be over the age of 20 by the date of departure.

I confirm I will be over 20 years old by the date of departure.

Application

Scan & Chat