Symposium Details

Details of participation

Event Name *

Participation Category *

Please select your registration category based on your professional status.

Participant Details

Personal details of participant

Full Name (without title) *

Degree *

Gender *

Date of Birth *

Email Address (Institution) *

Phone Number *

Institution *

Passport / Student ID Number *

Participation as ? *

Proof of Participation

Upload CV, Pas Photo, and ID Card

CV *

Click or Drop your CV here

PDF only (up to 10MB)

Pas Photo *

Click or Drop your pas photo here

PDF or Image (up to 10MB)

Passport / Student ID Card *

Click or Drop your ID card here

PDF or Image (up to 10MB)

Payment Proof

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Payment Proof *

Total registration fee to pay:

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Virtual Account Payment

VA JSMID

9887706200001928

PUSPAS UNAIR - JSMID 2026

BNI

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PDF or Image (up to 10MB)

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Terms and Conditions

Delegates from Indonesian must possess active accounts on Satu Sehat and Plataran Sehat platforms to comply with national health reporting standards.
Cancellation Policy: Please be advised that all registration fees for the seminar and/or workshop (hands-on) are non-refundable and non-transferable upon successful transaction.

I have read and agree to the Terms and Conditions and the Privacy Policy.

Symposium Details

Details of participation

Event Name *

Participation Category *

Please select your registration category based on your professional status.

Participant Details

Personal details of participant

Full Name (without title) *

Email Address *

Phone Number *

Institution Name *

NPA PDGI [10 digit NPA PDGI] *

NIK *

Proof of Participation

Upload Payment Proof

Payment Proof *

Total registration fee to pay:

-- Select Ticket First --

Virtual Account Payment

Nama Acara: JSMID

Nomor VA: 9887706200001928

Nama Rekening: PUSPAS UNAIR - JSMID 2026

Nama Bank: BNI

Need help with the payment process?

Click or Drop your payment here

PDF or Image (up to 10MB)

Almost done

Review your details and sign up

Terms and Conditions

Delegates must possess active accounts on Satu Sehat and Plataran Sehat platforms to comply with national health reporting standards.
Cancellation Policy: Please be advised that all registration fees for the seminar and/or workshop (hands-on) are non-refundable and non-transferable upon successful transaction.

I have read and agree to the Terms and Conditions and the Privacy Policy.

Registration Form

Symposium Details

Participant Details

Proof of Participation

Payment Proof

-- Select Ticket First --

Almost done

Terms and Conditions

Symposium Details

Participant Details

Proof of Participation

-- Select Ticket First --

Almost done

Terms and Conditions

Transfer Guide