Bali International Ophthalmology Review (BIOR) 2020

Registration Form

Please fill in the registration information below and submit back ASAP with the required applicable data.

DELEGATE RATES
IDR 7,000,000 (for Indonesia Residents only)
USD 550 (for Overseas Delegates)

Title (Dr./Prof./Mr./Ms.)

First name

Last name

Position

Clinic/hospital

Correspondence address

Country

Province/state

City

Zip code

Telephone

Mobile

Email

Fax

Name exactly to be written on BIOR Certificate

Register

Terms and Conditions

All BIOR 2020 conference registrations are made subject to the following terms and conditions:

1. Cancellation

If you have settled the payment and you cannot attend the event, the payment will not be refundable, but you can send a substitute.

2. No Deductions and Withholdings : The rates are NETT amount to be remitted with no deductions and withholdings for taxes or others purposes.

Hotel Information

Ayana Resort Bali

Hillside View Room (RIMBA)

Resort View Room (AYANA)

Registration

Payment Information

Booking a Room

Methods of Payment

Payment Information

Special Promo Rate

(on or before January 31, 2020)

IDR 4,000,000 (for Indonesia Residents only)

USD 300 (for Overseas Delegates)

On-site Registration

(November 1, 2019 onwards)

IDR 7,000,000 (for Indonesia Residents only)

USD 550 (for Overseas Delegates)

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Payment Information

Booking a Room

Methods of Payment

Official Venue Hotel

AYANA Resort and Spa Bali, Indonesia Jl. Karangmas Sejahtera, Jimbaran, Bali 80364 Phone: 62-361-702222

*All sessions and functions will be held at AYANA *Rates below are inclusive of breakfast

Please book me a room at

1. AYANA Resort and Spa Bali

Hillside View Room (RIMBA)

IDR 2,295,370

net/room/night

Resort View Room (AYANA)

IDR 3,632,420

net/room/night

2. None

None

Reservation Details

Number of Rooms

Check in date

Check out date

Delegate fees include access to all sessions, scheduled, lunches and refreshment breaks

Accompanying Person (optional)

Yes, I would like to register an accompanying person and pay an additional USD 250 ** for Overseas Delegates / IDR 3.500.000 for Indonesian Delegates.
(includes scheduled, lunches and refreshment breaks)

Number of accompanying person :

Name of accompanying person :

Title (Dr./Prof./Mr./Ms.)

First Name

Last Name

Title (Dr./Prof./Mr./Ms.)

First Name

Last Name

Title (Dr./Prof./Mr./Ms.)

First Name

Last Name

To also attend the Welcome Dinner, please add an additional USD 60** for Overseas Delegates / IDR 800,000* for Indonesian Delegates.

Number of Welcome Dinner :

*IDR rates are for Indonesia Residents only Conference Registration Fees
**USD rates are for Overseas Delegates Conference Registration Fees

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Payment Information

Booking a Room

Methods of Payment

Note: Seats are confirmed only upon receipt of full payment

Bank Transfer

(in Indonesian Rupiah / IDR)

Account name:
PT. Austindo Nusantara Jaya HealthCare

Account number:
8000 - 352 - 50200

Name of Bank:
PT. Bank CIMB Niaga, Tbk.

Address:
Jl. Jend. Sudirman Kav.58-Jakarta

Bank Transfer

(in US Dollar / USD)

Account name:
PT. Austindo Nusantara Jaya HealthCare

Account number:
8000 - 3608 - 9440

Swift Code:
CHAS US 33 a/c no 544-723151

Name of Bank:
PT. Bank CIMB Niaga, Tbk.

Address:
Jl. Jend. Sudirman Kav.58-Jakarta
(via JP Morgan Chase Bank, New York)

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Note:
Travel arrangements are the sole responsibility of the registrant. If the delegate wishes to cancel reservation, a one-day stay stay shall be charged upon notice. Please make your hotel reservation and payment at at least (2) months prior to the event. Room rates are subject to change without prior notice.

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Payment Confirmation

BIOR Registration

Registration Form

Payment Information

Special Promo Rate

On-site Registration

Please book me a room at

1. AYANA Resort and Spa Bali

Hillside View Room (RIMBA)

Resort View Room (AYANA)

2. None

Reservation Details

Accompanying Person (optional)

Methods of Payment

Bank Transfer

Bank Transfer

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