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Muktamar IKABDI XI & The 9th Annual IndonesianSymposium, Workshops on ACUTE CARE SURGERY 2020

Bandung, 12-15 Februari 2020

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Registration & Hotel Reservation Form ACS & Muktamar IKABDI

full name :

address:

phone/WA :

Email:

Sponsor:

Contact person:

No. Hp sponsor:

symposium acs :?

workshop:

PABI chapter :

IKABDI Chapter :

IKABDI member fee:PAID/UNPAID

reservation El Royale Hotel

check in :

check out:

payment registrasi acs & hotel reservation to:

Bank Mandiri cab rshs bdg

Acc Name : Acute Care Surgery

Acc Number : 132-00-1600-6000

Payment IKABDI member fee to:

Bank Mandiri Cab. RSHS Bdg

Acc Name : dr. Nurhayat Usman, SpB/ Haryono Yarman

Acc number : 132-00-120-9225-1

secretariat:

Diana 08156031673

Nina 0822 1643 8855

Nevi 0896 5739 3973