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 - Local Participant

State/Province

Zip Code

Telephone

Fax

Registration Fees (please select your category)

Category	Pre-Registration (before October 15, 2008)	On-Site Registration (after October 15, 2008)
Member	USD 350	USD 400
Non-Member	USD 400	USD 450
Student/Fellow	USD 200	USD 250
Accompanying Person (spouse)	USD 200	USD 200
Workshop	USD 150	USD 200

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 JAKARTA RSCM INDONESIA

No Account 122-00-0500868-8

Swift Code B E I I I D J A

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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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