Registration Form INHSP 2015
Full Name *
Your answer
Credentials (e.g.,MSN,MPH,MN,PhD,RN,etc.) *
Your answer
Affiliation/Institution *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Payment Choice *
Presentation Type *
Participant Type *
Address *
Your answer
Are You going to attend to the Cultural Night and Gala Dinner? *
There will be an additional charge for the Cultural Night and Gala Dinner (for participants package 2 and package 3) Rp. 160.000,- or USD 13
Are You going to join the Professional Visit and City Tour? *
There will be an additional cost for the Professional Visit and City Tour Rp. 100.000,- or USD 8
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