HOTELS & TRAVEL
• Hotel Options
• Flight Arrangement
• Visa Application
• Spouse Program
 
 
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
   
HOTEL RESERVATION - fill in if you want to reserve through the Committee.
Check In Pick a date pick a date.. Flight No
Check Out Pick a date pick a date.. Flight No
 
Total Night(s) X =
 
ONE NIGHT NON-REFUNDABLE DEPOSIT
 
NOTES: One Night Deposit non-refundable upon reservation. The remaining balance (full payment) should be settled by August 31, 2008 at the latest, otherwise, the reservation will be released automatically. For written cancellation received before August 31, 2008, 1 (one) night cancellation fee will apply and 100% cancellation fee (as per reservation) for cancellation after this date and no show.

Please INDICATE YOUR PREFERENCE No. next to room type (min. 2-3 preferences).
All rates are inclusive breakfast and valid for single/double occupancy.
HOTEL OPTION
STAR
ROOM TYPE
US$
Rp
GRAND HYATT BALI
*VENUE
*****
 Classic Room Garden
Classic Room Ocean
165
210
1,475,000
1,900,000
AYODYA RESORT BALI
*****
 Deluxe Garden View
Deluxe Ocean View
110
135
875,000
1,150,000
BALI DESA SUITE
****
 One Bedroom
Two Bedroom
75
95
650,000
850,000
INNA PUTRI BALI
****
 Superior Room
Deluxe Room
65
75
475,000
575,000
 
 
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
 
 
Newsletter Subscription
   
Full Name
Email
 
 
 
 
 
 
 
 
 
ASIA ANTI AGING IS SUPPORTED BY WORLD-WIDE PROMINENT MEDICAL ORGANIZATIONS & SOCIETIES: