Arte-Polis 7 International Symposium - Participant Registration Form
Please fill the form below to register as participant of Arte-Polis 7 International Symposium.

We want to inform that you also must to register as IndoBuildTech 2018 visitor here: http://www.indobuildtech.com/For-Visitors/Get-e-ticket

For payment method,, please make Bank Transfer payable to:

BANK MANDIRI, KCP Bandung Siliwangi - Bandung, INDONESIA. Swift Code: BMRIIDJA
- US Dollar: DR.Ing.Ir. Heru Wibowo, MURP, IAI - Acct.No. 130-00-0564603-2
- ID Rupiah: DR.Ing.Ir. Heru Wibowo, MURP, IAI - Acct.No. 130-00-0474754-2
Please write on message line: "AP7" and your Full Name

Send your proof of payment to our e-mail: oc@arte-polis.id AND artepolis@ar.itb.ac.id, with subject: AP7 - [FULL NAME]

(Fees do not include Bank Transfer charge, add as applicable)

Email address *
First Name *
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Middle Name
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Last Name *
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Name on Certificate *
Please write your desired name (including your salutation and title) to be written on certificate
Your answer
Salutation *
Institution/Organization *
Your answer
Mailing Address *
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City *
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State *
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Postcode *
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Country *
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Telephone *
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Faximile
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Mobile Phone *
Starts with country code (e.g. +628123456789)
Your answer
Participants Category *
Early bird registration AND payment must be proceed before 23 April 2018. For payment method, please read the information on top of this form. Send your proof of payment to our e-mail: oc@arte-polis.id AND artepolis@ar.itb.ac.id, with subject: AP7 - [FULL NAME].
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