Registration and Payment Confirmation Form

Full Name

Phone Number

Type of Registration

Indonesian Nationals

International Participants

Indonesian Students

International Students

Indonesian Non-Presenting Participant

Internetional Non-Presenting Participant

Title of Paper

If you are a presenter, please enter your paper title

Other People Registered in the Payment

If you are registering and paying for more than one person all at once, please mention the person's name. Please use new line for each person.

Payment Confirmation

Bank Transfer

Cash (Only for foreigners and those who have payment problem)

Name of Account

Name of Bank

Bank Account Number

Amount of Payment

Date of Payment Made

Proof of Payment