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B-ICON 2022 REGISTRATION
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Title
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Mr.
Mrs.
Ms.
Dr.
Prof.
First Name
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Your answer
Middle Name
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Last Name
(If your name only consists of 1 name, please rewrite your first name here
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Name for Certificate
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If you register as presenter, please type the name of author that will doing presentation in the day of conference)
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Nationality
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Institution
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Department / College / Faculty / Unit
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Address
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ZIP / Postal Code
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Country (Location of your institution)
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Email
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Mobile Phone No.
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Registration Fee Category
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Presenter - Indonesian - Regular IDR 500,000
Presenter - International - Regular USD 50
Participant (Online) - Regular IDR 50,000 / USD 10
Participant (Offline / On Venue) - Regular IDR 500,000 / USD 40
Participant (Online) - Polkeslu Student only IDR 10.000
Presentation Category
(If you register as a presenter, please tick the category of presentation below)
Oral Presentation
Video recording
Poster
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Do you have any special requirements / requests?
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How did you get to know about the conference?
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Poster
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Conference Alert
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Google Search
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Through the University / Institute or College
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