REGISTRASI ONLINE
 
Already registered?
click here
to confirm your payment, add workshop, etc.

REGISTRATION FORM
Registration Date
27/06/2019
 
REGISTRAN/SPONSORSHIP
Register Name
Same   Different with Participant  
PARTICIPANT
Reg. No.
[generate automaticaly]
Status
Peserta
Profession
Specialist   General Practitioner   Student  
Full Name
*
Full Name with Title
(Name will be printed on Certificate)
*
Address
*
Country
*
City/State
*
Mobile Phone
*
E-Mail
*
Access Key
[generate automaticaly] 
 
INSTITUTION
Name
Address
 
SIMPOSIUM
SIMPOSIUM
 
Early
Regular Rate
18 May 2019 to 23 Jun 2019
Onsite
Start From 24 Jun 2019
Specialist (Foreign)
26th-27th July 2019  
GP/ Resident/ Nurse (Foreign)
26th-27th July 2019  
WORKSHOP
WORKSHOP
 
Early
Regular Rate
18 May 2019 to 23 Jun 2019
Onsite
Start From 24 Jun 2019
NIV & Advanced Oxygen Therapy (Foreign)
25th July 2019  
Mechanical Ventilation (Foreign)
25th July 2019  
Disaster Management (Foreign)
25th July 2019  
Pleural Emergency in Disaster (Foreign)
25th July 2019  
Nutrition Aspect in Chronic Lung Diseases (Foreign)
25th July 2019  


HOTEL RESERVATION
Hotel
Room Rate
 
please select hotel first....
Room Count
1
Check in
Check Out
Total Night[s]
0 Disc.: Rp. 0,-
Total Hotel Fee
Rp. 0,-

BANK/ADDITIONAL INFORMATION

Transfer Via Following Account (USD Only):
BCA Branch Office Balai Pustaka
No. Acc. : 8810 4021 22
C/O. : FENI FITRIANI TAUFIK / LINDA FAUZI LUBIS
Swift Code: CENAIDJA

 

SUMMARY FEES