APASL 2008
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IMPORTANT DATES : Early Registration : before October 31, 2008. The abstract Submission Deadline : before November 10, 2008. The Working Committee APASL Consensus on HCC : December 04’ 2008. The 4th Conference of the STC : December 05 - 07’ 2008. HOME | CONTACT   
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APASL – 4th STC on
HCC Bali 2008
Secretariat:


Div. of Hepatology,
Dept. of Internal Medicine
Faculty of Medicine,
University of Indonesia

Ph. +62-21-3004 1026 ; 453 2202
Fax. +62-21-3004 1027 ; 453 5833
Email. apaslstc2008@cbn.net.id ; globalmedica@cbn.net.id
Website: www.apaslstcbali2008.org

 
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REGISTRATION & HOTEL RESERVATION FORM
(Please fill in with capital letter)

Complete and return this form to make sure that you will receive further information on the :
or download this form and send it to us

Title : Prof. Dr. Mr. Mrs. Ms.            
City / Country :
Name :
Postcode :
Institution :
Telephone :
Address :
Mobile Ph. :

Email

:


A.R E G I S T R A T I O N   F E E

Classification

Early Bird
(Before Oct. 31, 2008) *

After
Sept. 30, 2008
& On-Site

On-Site
APASL Member $100 $150 $200
Non APASL Member $150 $200 $250

Indonesian

Rp 750.000

Rp 1.000.000

Rp 1.250.000

* Payment received in Organizing Committee’s bank account
*** Valid APASL membership number required. Proof of APASL member is mandatory and
     must be sent with registration to the meeting secretariat


B.ACCOMODATION
(please mark ( )

Name of Hotel

Indonesian
( in Rupiah )

Foreigner
( in USD )

Grand Hyatt Hotel, Nusa Dua-BALI Grand Room (Left 100 rooms) IDR. 1.400.000,- USD. 150
Novotel Nusa Dua Deluxe Room (Fully Booked) IDR. 1.000.000,-

USD. 110

The Grand Bali Superior room (Left 50 rooms)

IDR. 700.000,-

USD. 80

- Full amount payment is required to confirm the registration & reservation before October 30th 2008.
- Please note that the O.C have booked limited numbers of room only. Due to Peak Season during this period of time concerning the government program “Visit Indonesia 2008”, we strongly advise you to book the room in advance and Secretariat will not be able to guarantee rooms after October 30th, 2008

Please indicate name of hotel preferred:
Occupancy : Single   Double ;  Check –In / Check- Out : / ; Total stay : night(s) ; Total room :  room(s)

Total Payment  :

Registration Fee

: (USD / Rp.)
Accommodation : (USD / Rp.)
Total : (USD / Rp.)
Payment Method : Bank Transfer Cash

 

Full amount payment is required to confirm the registration & reservation before September 30th' 2008. Official check-in time for the hotels is 14:00 hours and check-out is 13.00.

PAYMENT INSTRUCTIONS: 

Registration fees can be paid by the following methods:
By bank transfer is recommended :

  Bank Account APASL STC on HCC-Bali 2008
    A/N : APASL STC BALI
    A/C : 122-00-05014-32-2 ( US. Dollar )
          : 122-00-05014-30-6 ( IDR )
    Swift Code : beiiidja
    Bank : Mandiri Cab RSCM, Jakarta-Indonesia

Cash : to the Conference Secretariat or on-site

Important: All bank charges are the responsibility of the participant and should be paid at source in addition to the registration and accommodation fees.
If payment is made by a company or for more than one person, please make sure all names are indicated.

Registration may also be made on-site.

CANCELLATION POLICY
Registration & Accommodation: All cancellations must be received in written via faxed or electronically mailed before August 31, 2008.

Refund of registration fee and accommodation charges will be made as follows:
- Prior to September 30th , 2008 – Full refund less handling fee of 35
- From September 30th , 2008 - No refund
In the event of no-show, secretariat will automatically release and not allow to substitute to the others name, and all payments will be non-refundable.

     

I have read the general information and approved the processing of my registration. (please tick √ in the chosen box).    

Please Fax completed Registration & Hotel Reservation Form together with proof of bank remittance to Conference Secretariat:
Fax Back to: 62-21-30041027, 62-21-4535833




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