CONFERENCE
• Program at Glance
• Speaker Profile
• Accreditation Statement
• Certification
• Conference Venue
• Conference Registration
 
Please fill out completely.
 
Title
Full Name (to be printed on Certificate)
A4M Membership No. (if applicable)
Organization
Job Title
Field of Expertise
Mailing Address
City/State
Postcode
Country
Phone
Cellphone
Email
Fax
   
Conference Registration Type
INTERNATIONAL DELEGATE
INDONESIAN DELEGATE
Early Bird /
A4M Member
30 June’08
Regular
30 June’08
Early Bird /
A4M Member
30 June’08
Regular
30 June’08
Full Passport 10-12 Oct’08

US$ 500

US$ 650

Rp 3,900,000,-

Rp 4,900,000,-
Workshops D3: 12 Oct’08

US$ 200

US$ 300

Rp 2,000,000,-

Rp 2,500,000,-
Workshops D2: 11 Oct’08

US$ 200

US$ 300

Rp 2,000,000,-

Rp 2,500,000,-
Conference D1: 10 Oct’08

US$ 150

US$ 225

Rp 900,000,-

Rp 1,500,000,-
 
Spouse/Accompanying Person US$ 70 / Rp 600,000,- per day per person
person(s) x day(s). SPOUSE FULL NAME:
 
Australasia Hospital CEO Summit DINNER (11 Oct’08) US$ 45 / Rp 350,000 per person person(s)
 
Special Package US$ 980 / Rp 8,200,000,- INCLUSION:
Conference Full Passport & 3-nights at Grand Hyatt Bali Classic Room Garden
 
ABAARM Clinical Training Course 13-16 Oct’08 US$ 2,500 / Rp 18,900,000,-
 
 
We apologize that we are currently unable to process online registration with credit card payment. Please transfer payment to the following bank detail. Please fax your bank remittance to the Secretariat in order for us to identify and confirm your transfer. Thank you for your cooperation.
 
Account Name
Account No
Swift Code
Bank Name
Bank Address
 : ERA BUSINESS SOLUTIONS
: 670. 014.2882
: CENAIDJA
: BCA (Bank Central Asia)
: Jl. Bypass Ngurah Rai, Pertokoan Sanur Raya No.17, Bali—Indonesia
 
I agree with the terms and conditions of the Conference Registration.
 
 
 
 
PROGRAM HIGHLIGHTS
 
 

• Research Breakthrough Lectures
• Clinical Workshops & Live Demo
• World Class Expert Educators
• Inspiring Trade Expo
• Practice Building Opportunity
• Post-Conference Certification Course
 
 
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ASIA ANTI AGING IS SUPPORTED BY WORLD-WIDE PROMINENT MEDICAL ORGANIZATIONS & SOCIETIES: