<< Conference Participant Registration Form >>

Please complete this form to register for this conference. When finished, click on the Confirmation button below.

You may clear the form and start over by clicking on the Clear Details button
at the end of this page.

Registration Form

Details

Required fields are indicated with stars (*).

Conference *

iiWAS2003 MoMM2003

First Name*

Last Name *

Company/Organization/Institution*

Job Title*

Business Address*

City*

State/Province

Postcode

Country*

Telephone*
(country code+area+number)

Fax*
(country code+area+number)

Email*

Website

Participation Fee Requested : Please fill the number of person where applicable.
Participant fee is for 3 days conference, including lunches, coffee breaks, welcome reception, conference proceeding and conference kits

* must attach a letter of certification from the university

<< Payment Methods >>

Payments Options ( Payment Online not available)

Bank Transfer

Account no. 1006515942 (Currency US$)
Account no. 1005618951 (IDR)
Account holder : PT. Safitri Saptasejati
Bank Name : Panin Bank

Bank Address : Panin Bank Building
Jl. Jend Sudirman Jakarta, Indonesia

Swift Code PINBIDJA

Cheque

Made payable to PT. Safitri Saptasejati

Additional Arrangements : Please tick (?) where applicable.
Additional Charges may be applied. Form provided separately.

<< Important Notes >>

1. Participant’s registration is confirmed when full payment stated is received by iiWAS 2003
2. ‘Early bird’ is confirmed when payment is received by 1 September 2003. Payments received      after 1 September 2003 is regarded as an ‘Regular’ registration.
3. Registration fees include invited talks, paper presentations, tutorials, panel discussion,
    welcome  reception, conference dinner, lunches, coffee breaks and 1 volume of the conference     proceeding.
4. Substitution of individual attendees may be nominated. Cancellations must be made by
    3 September 2003 by fax or email - 20% administration fee will be charged.
    After 3 September all registrations are final.
5. Please ensure payments via ‘Bank Transfer’ is free of bank charges.

Copyright 2003 – iiWAS