test form - 5th APNNO Bali

Full Name (with/without title - for certificate purpose)

Contact Number (Mobile Phone)

Organization/Institutions/ Profession

Where do you hear about 5th APNNO BALI

Social Media Word of Mouth Email Other

Registration (early bird price) until 6th October

Regular Rp. 2,500,000 // ($250 ) Student Rp. 1,500,000 // ($150)

Payment Details :5th APNNO BALI official bank account :

Account Name : Koperasi Jasa Institut Riset Eijkman

Account Number : 122-00-07052-45-2

Bank Name : Bank Mandiri KCP Jakarta RSCM

SWIFT CODE : BMRIIDJA Jl. Diponegoro 71, Jakarta 10430, INDONESIA

Upload Proof Payment

Contact Person: whatsapp 0819 1650 5816 (CP: dr. Tesi) or

Email : 5thapnnobali@gmail.com

🚨 Warning: Stay vigilant against scams! 🛑 For 5th APNNO BALI Symposium transactions, use only the official bank account stated in this form. Don't fall prey to fraud—prioritize your security