ON-LINE REGISTRATION FORM
Wantilan Convention Center - SANUR BEACH BALI
Aerowisata Hotel & Resorts
Garuda Indoesia Group
Jl. Danau Tamblingan, PO Box 3279 80032, Bali - Indonesia
PERSONAL INFORMATION
Title
Mr.
Ms.
Name
Nationality
ID/Passport number:
Official Position
Institution
Office Address
Office Tel. No.
(incl. country & area code)
Office Fax No.
Mobile
E-mail (personal)
CONFERENCE FEE
REGULAR PARTICIPANT
Indonesian/KIMS holder - IDR 2,300,000
International/Non-KIMS holder - US$ 350
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