16^th CONGRESS OF THE INDONESIAN ORTHOPAEDIC and TRAUMATOLOGY ASSOCIATION
Combined With
6^th APOA HIP SECTION MEETING,
1^st MEETING OF ASEAN ARTHROPLASTY ASSOCIATION (AAA)
1^st MEETING OF THE INDONESIA HIP & KNEE SOCIETY (IHKS)
ASIA PACIFIC ORTHOPAEDIC SOCIETY for SPORT MEDICINE (APOSSM)

November 27^th- 29^th, 2008
BALI INTERNATIONAL CONVENTION CENTER
THE WESTIN RESORT NUSA DUA BALI

Registration Form

Hotel Reservation Form

Registration Form

PERSONAL PARTICULARS

Title Prof Dr Mr Mrs Ms

Full Name

Name of Badge (limited to 15 alphabet)

Institution

Address

City

Country Indonesia - Overseas Participant

Province

Post Code

Telephone

Fax

Registration Fees (please select your category)

Category	Pre-Registration (before October 15, 2008)	On-Site Registration (after October 15, 2008)
Member	Rp 3.000.000	Rp 3.500.000
Non-Member	Rp 3.500.000	Rp 4.000.000
Orthopaedic Resident (Only 100 Residents will get free)	Free	Free
Accompanying Person (spouse), incl: - Welcome Party - Barbeque Dinner - 2 Days Tour	Rp 2.000.000	Rp 2.000.000
Workshop (4 companies)	Rp 1.500.000	Rp 2.000.000
General Practice (Scientific and Exhibition only)	Rp 1.500.000	Rp 2.000.000
Welcome Party (Cocktail and Banguet Dinner only)	Rp 750.000	Rp 750.000
Nurse Workshop	Rp 500.000	Rp 500.000

Payment Method

All payment to be issued in favour of the "Indonesian Orthopaedic Association"

Payment can be transferred to:

Name of Account P.A.B.O.I / I.O.A

Bank MANDIRI / KCP RSCM, JAKARTA, INDONESIA

No Account 122-00-0500862-1

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indonesia-orthopaedic.org - Department of Orthopaedic Surgery
Dr.Cipto Mangunkusumo Hospital / Faculty of Medicine University Indonesia
Jl. Diponegoro No.71, JAKARTA 10430, INDONESIA. Phone : 62.21.3929655 / 3917378, Fax : 62.21.3905894
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