Arte-Polis 7 International Symposium - Participant Registration Form
Please fill the form below to register as participant of Arte-Polis 7 International Symposium.

We want to inform that you also must to register as IndoBuildTech 2018 visitor here: http://www.indobuildtech.com/For-Visitors/Get-e-ticket

For payment method,, please make Bank Transfer payable to:

BANK MANDIRI, KCP Bandung Siliwangi - Bandung, INDONESIA. Swift Code: BMRIIDJA
- US Dollar: DR.Ing.Ir. Heru Wibowo, MURP, IAI - Acct.No. 130-00-0564603-2
- ID Rupiah: DR.Ing.Ir. Heru Wibowo, MURP, IAI - Acct.No. 130-00-0474754-2
Please write on message line: "AP7" and your Full Name

Send your proof of payment to our e-mail: oc@arte-polis.id AND artepolis@ar.itb.ac.id, with subject: AP7 - [FULL NAME]

(Fees do not include Bank Transfer charge, add as applicable)
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Email *
First Name *
Middle Name
Last Name *
Name on Certificate *
Please write your desired name (including your salutation and title) to be written on certificate
Salutation *
Institution/Organization *
Mailing Address *
City *
State *
Postcode *
Country *
Telephone *
Faximile
Mobile Phone *
Starts with country code (e.g. +628123456789)
Participants Category *
Regular registration AND payment must be proceed before 2 May 2018. All late paid early bird registration will be determined as regular registration. For payment method, please read the information on top of this form. Send your proof of payment to our e-mail: oc@arte-polis.id AND artepolis@ar.itb.ac.id, with subject: AP7 - [FULL NAME].
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