The 13th IKARGI National Symposium Registration Form Personal DetailsFill in the following data correctly and completelyFull Name *(Without any title, abbreviation and other remarks)E-mail Address *Phone Number *(WhatsApp number is preferred)NPA PDGIRequired for Indonesian dentists/specialists (https://sertifikasi.pdgi.or.id/cek-dokter-gigi)Nomor Induk Kependudukan (NIK) *Required for Indonesian nationalities, as each participant must have an account on the LMS Plataran Sehat KEMENKES to obtain SKP creditsSymposium RegistrationSelect the participant category and program you wish to joinSymposium Participant Category *DMFR Specialist and/or IKARGI MemberDMFR ResidentGeneral Practitioner (Only Main Symposium 2 Days)General Practitioner (Day One of Symposium)International Participant (USD 130)Registration for DMFR Specialist, DMFR Resident, and General PractitionerSymposium Participant Category(Registration for General Practitioner To Be Announced)Confirmation of Participation in Rakernas IKARGI (Evening Thursday, June 4th) *Yes, I'm joining inNo, I'm unable to attend(Exclusively for IKARGI Full Members & Free of Charge)Confirmation of Participation in Phinisi Sunset Sailing (Evening Friday, June 5th) *Yes, I'm joining inNo, I'm unable to attend(If there are any additional fees, they will be announced later)Confirmation of Participation in IKARGI Gala Dinner (Evening Saturday, June 6th) *Yes, I'm joining inNo, I'm unable to attend(Exclusively for IKARGI Members & Free of Charge)Total Symposium FeeRp.(Total Symposium Fee to Be Paid)Total Invoice AmountRp.(Total Invoice to Be Paid)Payment *Bank TransferTransfer BankBank MandiriNo. Account 152-0000-996161a/n Simposium Nasional XIII IKARGIUpload Proof of Payment *Choose FileNo file chosenDelete uploaded fileConsent(Place a check mark next to all the conditions below)By submitting this registration form, all Indonesian dentist and specialist participants of the 13th IKARGI National Symposium are required and already have an active account on the LMS Plataran Sehat to obtain SKP credits from the Indonesia's Ministry of HealthAll funds paid to the committee are non-refundable for any reason, except in the event of cancellation or other force majeure conditions. I have read and agree to this statement.SUBMITSave as DraftPlease do not fill in this field.