Registration Form
Information Participant
Full Name
Email
NIK (Identity Number)
NIK must be 16 digits.
Phone Number
Institution
Participant Type
Pilih Jenis Peserta
General Practitioner
Nurse
Resident
Specialist
Registration Status
Personal
Sponsor
Company Name
PIC Sponsor
Phone Sponsor
Workshop Event
Workshop Hypospadia + Hands On
Specialist
(Remaining Quota: 7)
Rp 5,000,000
Workshop Hypospadia + Hands On + Symposium
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738
Rp 7,000,000
Workshop Microsurgery
Specialist
(Remaining Quota: 14)
Rp 8,000,000
Workshop Microsurgery + Symposium
Rp 10,000,000
Workshop Basic (Short Symposium + Dry Lab)
Specialist
(Remaining Quota: 14)
Rp 3,000,000
Workshop Complete ( Basic + Nephrectomy + CAPD)
Specialist
(Remaining Quota: 16)
Rp 15,000,000
Workshop Complete ( Basic + Nephrectomy + CAPD) + Symposium
Rp 17,000,000
Workshop PCNL / RIRS
Specialist
(Remaining Quota: 10)
Rp 5,000,000
Workshop PCNL Assistant (for Nurse)
Nurse
(Remaining Quota: 8)
Rp 1,500,000
Workshop PCNL / RIRS + Symposium
Rp 7,000,000
Symposium Event
Simposium Specialist
(Specialist)
(Regular)
Rp 3,000,000
Simposium Resident
(Resident)
(Onsite)
Rp 1,000,000
Simposium General Practitioner
(General Practitioner)
(Regular)
Rp 1,500,000
Simposium Nurse
(Nurse)
(Regular)
Rp 1,000,000
Accommodation
Check-in Date
Check-out Date
Shangri La Hotel
Deluxe Room
Rp 1,600,000/night
Total Payment:
0
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