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Registration
OFFLINE SYMPOSIUM
PERKENI Member
Anggota PERKENI?
Anggota PERKENI
Your Profession
*
Specialist/Fellow
Resident/GP
Medical Student/Health Practitioner
Symposium Fee
*
Email Address
*
Full Name
*
NIK
*
Location
*
Institution
*
Mobile Number
*
Workshop Offline, 26 September 2024
See Schedule
Fee per Workshop
Morning Workshop
*
WS 1
WS 2
No
Noon Workshop
*
WS 3
WS 4
No
Workshop Fee
Hotel Accommodation
Kyriad Muraya Hotel Aceh ⭐⭐⭐⭐ IDR 1.450.005/night
Untuk Pemesanan Hotel Silahkan Hubungi PANITIA
Total Registration Fee
Payment Method
Transfer
Guarantee Letter
Transfer to
PB PERKENI Bank Account
Bank Mandiri KCP RSCM Jakarta Jalan Diponegoro 71, Jakarta
1220007788287
Upload Payment Receipt
Choose File
Upload Payment Receipt
Choose File
Guarantee Letter yang diajukan harus dengan
Kop surat perusahaan
Cap basah perusahaan
Tanda tangan pejabat yang berwenang
Informasi waktu pembayaran
Nomer telepon yang bertanggung jawab terhadap Guarantee Letter tersebut
Upload Guarantee Letter
Choose File
Upload Guarantee Letter
Choose File
Upload Selfie Anggota
Upload
Upload Selfie Anggota
Upload
Registrant
*
Personal
Sponsor
Sponsor Name
*
PIC Email
*
PIC Name
*
PIC Phone Number
*
Only fill in if you are not human
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