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REGISTRATION FORM
PARTICIPANT
Name
City
Hospital / Company
Phone
SPONSOR
Company
Contact Person
Phone
PRE-SYMPOSIUM Workshop & Course
BALI RANI HOTEL (30 July, 2018)
BALI RANI HOTEL (31 July - 1 August, 2018)
FAVE HOTEL (31 July - 1 August, 2018)
BALI RANI HOTEL (1 August, 2018)
FAVE HOTEL (1 August, 2018)
MAIN SYMPOSIUM
REGISTRATION FEE (2 - 4 August, 2018)
POST SYMPOSIUM Workshop & Course
FAVE HOTEL (4 August, 2018)
DISCOVERY KARTIKA PLAZA HOTEL (4 August, 2018)
BALI RANI HOTEL (4 - 5 August, 2018)
ACCOMODATION FORM
HOTEL LISTS
Check in
date_range
Check out
date_range

*)All price nett/night
*)Your reservation will cancel if payment have not received within 2 weeks after registration
*)50% cancellation fee (as per reservation) will be charged for cancellation received after xxxxx
*)100% cancellation fee (as per reservation) will be charged for cancellation received after xxxxx


SOCIAL PROGRAMS

After submiting this form, you will receive an email regarding your registration and terms of payment.

If you need more info please do not hesitate to contact us at nqcitra@gmail.com / +62 813-1822-0387.

Thank you.

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REGISTRATION INFORMATION

PAYMENT
Payment can be made through cash or bank transfer in full amount (US Dollar / Rupiah). A Copy of bank documents must be forwarded by email together with the forms, payable to :

BANK ACCOUNT :

Bank : Mandiri Jakarta RS. Harapan Kita
Account no : 117-00-0648045-3
Name: Perhimpunan Kedokteran Gawat Darurat Indonesia.
Branch code : 11728
Swift code : BMRIIDJA

Notes :

  • The Participants should pay handling fee for the remittance
  • Plaese attach a copy of the bank remittance to the registration form for our reference
  • Bank remittance should be made under tha participant’s name
  • The receipt of the registration form will not be acknowledged until the appropriate registration fee has been received by the secretariat. The confirmation will be issued at least 7 working days after the organizing committee receives the fund
  • An official receipt will be issued upon receipt of the registration fee
  • Participants are requested to produce the receipt at the registration desk to obtain the symposium kit
  • The participant should get onsite cost if they paid more than August 1st
  • The participant who register from July 15th – onsite is possible not to get symposium kit

CANCELLATION & REFUND
There will be a 25% charge for written cancellation made 3 months before the event. There will be a 50% charge for written cancellation made 1 months before the event and will be no refund for less more than 1 month.

REGISTRATION AT ThE SYMPOSIUM VENUE
Re – registration and on site registration will be accepted at Discovery Kartika Plaza Hotel, Kuta Bali Indonesia.

ACCOMMODATION INFORMATION

HOTEL RESERVATION
The organizing committee has secure accommodation for participant. Application for accommodation must fill out the accommodation form accompanied by a non refundable 1 night deposit after 2 weeks registration balance (Full Payment) must be paid by (July 15, 2018) at the least, and otherwise the room reservation will be automatically released. This deposit is to guarantee the room with special rate provide to the symposium participants. All requests will be proceed on first come first serve basis. If certain hotel has been booked out, the Organizing Committee has the right to relocate to another hotel preference chosen. The reservation will be closed at June 30, 2018.

PAYMENT PROCEDURES
Each participant should complete the Accommodation form and email it back together with the appropriate payment receipt to symposium secretariat NQ Citra, email : nqcitra@gmail.com, attn : Ms. Ika. All payment must be paid in USD (for Overseas and non KIMS Holders) and Rupiah (for Indonesia and KIMS Holder) to :

BANK ACCOUNT :

Bank : Mandiri Jakarta RS. Harapan Kita
Account no : 117-00-0648045-3
Name: Perhimpunan Kedokteran Gawat Darurat Indonesia.
Branch code : 11728
Swift code : BMRIIDJA

CANCELLATION
The committee will cancel the reservation if no received 1 night non refundable deposit after 2 weeks registration. 50% cancellation fee (as per reservation) will be charged for cancellation received after (June 22, 2018) and 100% cancellation on/after (July 15 , 2018)