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Accommodation Form
INAVASC XVI
Registration Form
Participant Category
*
Please select your participant category
General Practitioners
Member PESBEVI
Nurses
Specialists (Non Surgeon)
Surgeons
Academic Title (Prefix)
Optional: title placed before your name
Full Name
*
Note: Your name based on ID/KTP for certificate (without title)
Academic Title (Suffix)
Optional: title placed after your name
NIK
NIK must be exactly 16 digits!
Note: for certificate (Must be exactly 16 digits)
Phone Number
Note: please input phone number start with 62
Email
Email Plataran Sehat
Province
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City
- select province first -
Workplace/Institution
Sponsorship?
*
No
Yes
Sponsor Name
*
Sponsor Phone
*
Note: start with 62
Upload Sponsor Letter
*
PDF only, max 2MB
Workshop
Please select a Participant Category first.
Symposium
Please select a Participant Category first.
Symposium: 23–24 October 2026
Gala Dinner
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Gala Dinner: 23 October 2026
Notes
Workshop:
0
Symposium:
0
Gala Dinner:
0
Total:
0
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