Form – UNICOPPS

UNICoPPS

Registration has been closed.

POSTER PRESENTATION

Please fill out ALL FIELDS on the form below to register.

Before submitting the form, please make sure that you have completed all fields correctly. Please register your daily email, since further communication will be done ONLY through email.

DO NOT use special characters such as # & ^ ' " $ % etc

Full Name *

Gender *

Birth Year *

Email *

Institution *

Country *

Phone Number *

Publication Submission

Proof of Payment *

Terms * I confirm data entered is correct.

Full Name*

You will act as the corresponding author. Please fill the name with degree title.

Institution *

Email*

One email address only. An activation link will be sent to your email. This email can NOT be changed, and will be used in ALL correspondence as the email of corresponding author. Email can NOT be changed after registration.

Postal Address*

Phone Number*

Title*

Scope*

Publication Submission

Proof of Payment *

Maximum file size: 20 MB

Payment Terms: Payment must be made to the following BRI bank account: Account number: 0409-01-000185-30-9 Account name: Fakultas Kesehatan Unjani Yogyakarta A unique code "3" must be added to the end of the payment amount (e.g., IDR 400,003) All payments are non-refundable.

Terms*

The data I entered in the online registration form is correct and valid

By submitting this registration, I agree to the terms and conditions and privacy policy.