REGISTRATION FORM

SYMPOSIUM (August 11th – 12th,2017)

PARTICIPANT Up to June 16th, 2017 June 17th– July 28th, 2017 July 29th, 2017 – On Site
Specialist IDR 1,500,000.- IDR 1,700,000.- IDR 1,800,000.-
GP/ Resident/ Nurse IDR    900,000.- IDR 1,000,000.- IDR 1,100,000.-
Student IDR    750,000.- IDR    900,000.- IDR    900,000.-

WORKSHOP (August 9th – 10th, 2017)

PARTICIPANT Up to June 16th, 2017 June 17th– July 28th, 2017 July 29th, 2017 – On Site
Good Clinical Practice (GCP)  IDR 1.900.000  IDR 2.100.000  IDR. 2.300.000

WORKSHOP (August 10th, 2017)

PARTICIPANT Up to June 16th, 2017 June 17th– July 28th, 2017 July 29th, 2017 – On Site
Mechanical Ventilation IDR 1,700,000.- IDR 1,900,000.- IDR 2,000,000.-
Pleural Diseases IDR 1,700,000.- IDR 1,900,000.- IDR 2,000,000.-
Oxygen & Inhalation Therapy IDR 1,700,000.- IDR 1,900,000.- IDR 2,000,000.-
Lung Function IDR 1,700,000.- IDR 1,900,000.- IDR 2,000,000.-
MTA in Conduct The Research IDR 1,500,000.- IDR 1,700,000.- IDR 1,900,000.-

For printed form, download here.

Any payment, can be  transfer via following account :
C/O                     : RESPINA
Bank                   : Bank Rakyat Indonesia (BRI)
KK RS Sulianti Saroso Sunter
No. Account       : 1205.01.000014.30.9

Bank chargers will be borne by participants
Please send via email for payment confirmation to:

SECRETARIAT RESPINA
info.respina.indonesia@gmail.com / info.respina@yahoo.com
For Confirmation please call :
Phone   : (62-21) 2961 4273
HP          : +62 813 8200 8877 / +62 857 1933 5220