Registration
OFFLINE SYMPOSIUM
Voucher 50%

Voucher*

Anggota PERKENI?

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Your Profession*

Specialist/FellowResident/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*

Noon Workshop*

Workshop Fee

Hotel Accommodation

Kyriad Muraya Hotel Aceh ⭐⭐⭐⭐ IDR 1.450.005/night

Untuk Pemesanan Hotel Silahkan Hubungi PANITIA

Total Registration Fee

Total After Discount

Payment Method*

TransferGuarantee Letter

Transfer to PB PERKENI Bank Account Bank Mandiri KCP RSCM Jakarta Jalan Diponegoro 71, Jakarta 1220007788287

Upload Payment Receipt*

Guarantee Letter yang diajukan harus dengan

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Registrant*

PersonalSponsor

Sponsor Name*

PIC Email*

PIC Name*

PIC Phone Number*

Only fill in if you are not human