AIWEST-DR 2018 Registration Form
We are happy to welcome you in Banda Aceh at the The 11th Aceh International Workshop and Expo on Sustainable Tsunami Disaster Recovery (AIWEST-DR 2018).

Please complete all steps during the registration process. It isn’t possible to save or return to an incomplete registration. You can return to a previous step if you want to change anything. When you register, you can create a user account: this allows you to access your registration later on and update it if needed.

PERSONAL DETAILS
First Name *
Your answer
Last Name *
Your answer
Title *
Gender *
Affiliation *
Your answer
Email *
Your answer
ADDRESS
Street, City and Postcode
Your answer
State *
Your answer
Country *
Your answer
Phones
Please start with "+" and country code. Ex: +1 23 456 789
Direct/ Business:
Your answer
Mobile *
Your answer
REGISTRATION CATEGORY
As Presenter
As Non-presenting participants
REGISTRATION FEES PAYMENT METHOD
BANK NEGARA INDONESIA Branch: Banda Aceh
Account Number: 0717 6019 41
Account Name: AIWEST DR
SWIFT CODES/BIC CODE: BNINIDJABDA


Please forward a scanned copy of the transfer receipt to : aiwest-dr@tdmrc.org

WORKSHOP SECRETARIAT
TDMRC Building, 3rd floor
Jl. Prof. Dr. Ibrahim Hasan, Gampong Pie,
Kec. Meuraxa, Banda Aceh, Indonesia. 23233
Tel. (0651) 8052009
E-mail: aiwest-dr@tdmrc.org
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This form was created inside of Tsunami and Disaster Mitigation Research Center (TDMRC).