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8th IVSA Asia Conference Indonesia Application Form
IVSA Chapter Indonesia Proudly Present :
THE 8TH IVSA ASIA CONFERENCE in Malang-Surabaya Indonesia 2017

Theme : Animal Health for a Better World

1. Fee : 300 euro (NOT INCLUDED: FLIGHT TICKET and VISA)

2. Place : Surabaya and Malang, East Java, Indonesia

3. Date : 07 to 13 August 2017 .

Please fill this form no longer than 30th March 2017 at 17.00 (GMT) and please frequently check your email for further information.
Any question regarding the selection please kindly contact us through our Email:
8thasiaconfindo@gmail.com

Thankyou, and Good Luck!

Full Name *
Your answer
Nick Name *
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Sex *
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Phone Number *
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IVSA Chapter : *
Example: IVSA Chapter Indonesia
Your answer
Country of Residence *
Your answer
Nationality *
Your answer
University *
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Year *
Required
Birth Date *
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Passport Number *
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Email Address *
Your answer
Position in Member Organization *
Contact Emergency Call (Family) *
Example: Mr. Abiyyu (Father) +62888877666 abiyyu.oke@XXXX.com
Your answer
Have you ever joined any IVSA program before? If yes, please mention *
Your answer
Special Dietary (All food in Indonesia will be Halal ) *
Medical Information *
Example: Asthma, Allergic, Gastric Ulcer
Your answer
T-Shirt Size *
Describe your Motivation by joining 8th Asia Conference Indonesia: *
Your answer
What do you know About IVSA Asia Conference? *
Your answer
What do you Expect About IVSA Asia Conference? *
Your answer
Describe your opinion about "Animal Health for a Better World" *
Your answer
I am aware that Organizing Committes (OC) can not be held Responsible for any injuries or damages inflicted by me, or any harm that may come to me while attending the Conference. *
I understand that the Asia Conference (and Post Conference) fee is NON-REFUNDABLE and that i will not be issued a refund if I miss all or part of the event. *
Required
Do you want to Join Post Conference 8th Asia Conference? *
Dates: August,13 to August 16 2017 | Cost : 270euro. | Location : Bali Island ( Denpasar-Ubud-Kuta-Jimbaran)
If you're extending your stay in Indonesia and not joining the Post Conference, where are you going to be? *
Do you need any VISA Requirement?
Disclaimers *
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