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Registrasi Form
Participant Category
*
Please select your participant category
General Practitioner
Nurse
Resident Trainees
Specialist
Specialist
General Surgeon
Vascular and Endovascular Surgeon
Cardiothoracic and Vascular Surgeons
Plastic Surgeon
Pediatric Surgeon
Orthopedic Surgeon
Full Name
*
Note: Your name based on ID/KTP for certificate
NIK
Note: for certificate
Phone Number
Note: please startwith 62
Email
Note: please use your email Plataran Sehat
Province
- please select one -
ACEH
SUMATERA UTARA
SUMATERA BARAT
RIAU
JAMBI
SUMATERA SELATAN
BENGKULU
LAMPUNG
KEPULAUAN BANGKA BELITUNG
KEPULAUAN RIAU
DKI JAKARTA
JAWA BARAT
JAWA TENGAH
DAERAH ISTIMEWA YOGYAKARTA
JAWA TIMUR
BANTEN
BALI
NUSA TENGGARA BARAT
NUSA TENGGARA TIMUR
KALIMANTAN BARAT
KALIMANTAN TENGAH
KALIMANTAN SELATAN
KALIMANTAN TIMUR
KALIMANTAN UTARA
SULAWESI UTARA
SULAWESI TENGAH
SULAWESI SELATAN
SULAWESI TENGGARA
GORONTALO
SULAWESI BARAT
MALUKU
MALUKU UTARA
P A P U A
PAPUA BARAT
City
Workplace/Institution
Example: Inavasc Hospital
Sponsorship?
*
Yes
No
Sponsor Name
*
Sponsor Phone Number
*
Note : please startwith 62
Upload Sponsor Letter
*
Click the area to upload file
Note: Please upload your sponsorship letter; 1 file (pdf) maximum 2mb
Workshop
AV FISTULA CREATION
5.000.000
VEIN STRIPPING & PHLEBECTOMY
4.000.000
VASCULAR ULTRASOUND & SCLEROTHERAPY
4.000.000
UP TO DATE WOUND MANAGEMENT
4.000.000
Workshop: 16 October 2025
Symposium
ONSITE
-
Symposium: 17-18 October 2025
Gala Dinner
Gala Dinner
500.000
Gala dinner: 17 October 2025
Notes
Workshop:
0
Symposium:
0
Gala Dinner:
0
Total:
0
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