IPRA INTERNATIONAL CONFERENCE 2010 - JAKARTA, INDONESIA
 

Please fill in all fields marked with a *

PERSONAL INFORMATION
Participant *
First Name * Last Name *
Company / Institution *
Position *
Address *
City / ZIP Code * Country *
Telephone * Fax
Email *
Preferred name on badge *

ACCOMPANYING PERSON (if any)
Accompanying Person *
First Name * Last Name *
Preferred name on badge *

FLIGHT SCHEDULE
Arrival Date (dd/mm/yy) * Time * Flight No *
Departure Date (dd/mm/yy) * Time * Flight No *
CONFERENCE REGISTRATION FEE
  REGISTRATION Regular Fee
(after 30 October 2009)		  
IPRA Member USD 750  
Non IPRA Member USD 1,250  
Academia USD 900  
Accompanying Person USD 500  

PAYMENT METHOD
Payment  

Note: * Please indicate copy of your membership to get special rate for IPRA
* Academia is only for full time teaching sta/students,
please provide reference letter from Institution. Academic rate valid until 15 January 2010