2016-04-25 08:00:00

Foreign Participant

REGISTRATION FORM (CHAMBER SESSION) FOREIGN PARTICIPANT

Personal Information

Title *
Full Name *(As in passport if letter is needed for visa application)
Name of Institution / Organisation *
Position in the Institution/ Organisation *
Address of Institution / Organisation:
Country
E-Mail Address *
Telephone No *
Fax No
Entry Visa I need a customized letter of Invitation with my passport details (Passport number / Travel Document Number):
Conference Participation

Flight Schedule

Arrival to Jakarta International Airport (Pick up only available on 24 April 2016)

Date
Time HHMM
Flight Number

Departure

Date
Time HHMM
Flight Number
Transportation
Will you have your own means of pick up?YesNo (will be picked up by the OC at group basis)
Contact Person at the University (In case of Emergency) :

Accommodation

Need help with your accommodation?
Accomodation (Margo Hotel Depok "twin share")Yes (book me a single occupancy with additional personal charges)No (Margo Hotel Depok, twin shared room provided by OC)
Notes : Additional charge : Rp. 500.000/night. The cash payment (IDR) should be made upon your arrival at the hotel (International Office Registration Desk)

Side Activities

Faculty Visit Will you join the site visit to faculty (if yes, please identify the faculty)
Research Center Visit
Will you join the excursion?
Excursion Indonesia Miniature Park - FreeYesNo
Gala Dinner Will you join gala dinner on 25 April 2016?
Food/Dietary Restriction
YesNo
If Yes, Please mention

Abstract Submission

Select Sub-Theme
Title of Presentation :
File Upload Accepted File Ext pdf|doc|docx

Verification

Please enter any two digits *Example: 12
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(c) 2016 International Office - Universitas Indonesia