Registration - 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

Note: for certificate (Must be exactly 16 digits)

Phone Number

Note: please input phone number start with 62

Email Plataran Sehat

Province

City

Workplace/Institution

Sponsorship? *

Workshop

Please select a Participant Category first.

Symposium

Please select a Participant Category first.

Symposium: 23–24 October 2026

Notes

Total:0