×
Default Modal Tittle
Body goes here...
registration
cart:
Already registered?
click here
to login.
REGISTRATION FORM
Registration Date
12/10/2025
PARTICIPANT/SPONSORSHIP REGISTRATION
Registered by
Self Registered
Sponsor Registered
Register Name
*
Mobile Phone
*
E-Mail
*
Company Name
- NO SPONSORSHIP -
Dr Lisnawati
-
- OTHER -
ABBOTT
ACTAVIS
ALERE
ALPHARMA
APEX PHARMA
ARMOXINDO
ASTA MEDICA
ASTELLAS PHARMA INDONESIA
ASTRAZENECA INDONESIA
AVENTIS PHARMA
AXCELOR
B BRAUN MEDICAL INDONESIA
BAXTER
BAYER CORP
BAYER INDONESIA
BEAUFOUR IPSEN
BECTON DICKINSON
BERNA
BERNOFARM
BESINS HEALTHCARE
BINA SEHAT
BINTANG TOEDJOE
BIOLIFE
BIOMEDIS
BIOMERIUX
BIOSENSORS
BIOVIT
BOEHRINGER INGELHEIM
BRISTOL
BRISTOL-MYERS SQUIB
CAPRIFARMINDO
CENDO
CHEVRON
COMBIPHAR
CORONET
CORSA
DARYA-VARIA
DEXA MEDICA
DINA MENDINO
DKSH
DOXA
Dr Anitta Flo
Dr Dicky
Dr dr Fauziah Fardizza, SpTHTB
Dr dr Wahju Aniwidyaningsih, S
DR LIDIA GIRITRI BANGUN
dr M Reynalzi Yugo
dr Madeline
dr Pompini SpP
Dr Retno wihastuti
dr Santi Rahayu Dewayanti
dr Shaogi Syam
dr Shintawati Zainudin SpP
Dr vinci edy wibawa spP
dr Yulia Rosa Saharman, SpMK(K
dr. Airin Aldiani, Sp.P
Dr. Andi Dala, Sp.KFR
dr. Anggie Indari
dr. Annisa Dian, Sp.P
dr. Buti Ariani
dr. Dian Prastiti, Sp.P
dr. Dian Yulianti SpP K-(Onk)
dr. Hindiyati Nuriah SpOk
Dr. Hindiyati Nuriah, SpOK
Dr. Januar Habibi
dr. Januar Habibi, SpP
Dr. Kasum Supriadi SpP
Dr. Kevin Triangto
dr. Lela Di Sary, Sp. FK
dr. Linda Masniari, Sp.P
dr. Pradjna Paramita SpP
Dr. Rahmanofa
dr. Rita SpP
Dr. Shynta Hantogo Sp. KFR
dr. Sri Dhuny Atas Asri
dr. Vinci edy wibawa
dr. Yulia Rosa Saharman Sp.MK(
dr.aulua
Dwi Handoko
EISAI
ERLIMPEX
ESCOLAB
EURO-MED
FAHRENHEIT
FERRON
FOURNIER
Free kupon respiquizz
FREE POSTER REGISTRATION
FRISIAN
FUTAMED
GLAXO
Global Health
GLOBAL MULTI
GRACIA PHARMINDO
GUARDIAN
HARMONI PRIMA MEDIKA
HEARTWARE
HELSINN
HEXPHARM
IDS MEDICAL INDONESIA
IKAPHARMINDO
INDO FARMA
INDRA SAKTI
INFION FARMASI
INMARK
INTERBAT
ISTI KARYA PERSADA
JANSSEN
JEMBATAN DUA
JOHNSON&JOHNSON
KALBE FARMA
KARINDO ALKESTRON
KIMIA FARMA
KONIMEX
Kupon Peserta E-Poster
LAPI
LAWSIM
LEDERLE
LES LABS
LYEMPF
MAHAKAM BETA FARMA
MEAD JOHNSON
MEDICHEM
MEDIFARMA
MEDIKON
Medquest Jaya Global
Medtronic
MEGA
Mega Lifesciences
Mega Pratama Medicalindo
MEIJI
MEPROFARM
MERAPI UTAMA PHARMA
MERCK
MerckSharpDohme Pharma Tbk
MERSIFARMA
METISKA
MILLENINUM
MITRA KESEHATAN JAYA
MUGI
Mustika
NESTLE
NEW ZEALAND
NICHOLAS
NOVARTIS INDONESIA
NOVELL
NOVO
NUCLEUS FARMA
NUFARINDO
NUGRAKARSERA
NUTRICIA
NUTRINDO
ONCOCARE
ORGANIZING COMMITTEE
ORGANIZING COMMITTEE
ORGANON
OTSUKA
OTTO
PACIFIC BIOTEKINDO
PARAGERM
PERSONAL
PFIZER
PHAPROS
Pharmasolindo
PHAROS
PHAROS
PHILIPS RESPIRONICS
PHYTO KEMO
PRAFA
PRIMA HEXAL
PRO-HEALTH
PROBUS
PRODIA
Prof Erlina
Prof Erlina Burhan
Prof Erlina, Sp.P(K)
Prof. Dr. dr. Erlina Burhan, S
Prof. Dr. dr. Erlina Burhan, S
Prof. dr. Erlina Burhan,SpP(K)
Prof. Erlina Burhan, Sp.P(K)
PROMED RAHARJO
PT Endo Indonesia
PT Wellesta CPI
PT WORLD HOLIDAY TRAVEL
PT. Alexa Medika
PT. Anugerah Pharmindo Lestari
PT. Axcelor Ultima Management
PT. Citra Vita Buana
PT. Clinisindo Putra Perkasa
PT. DEMKA SAKTI
PT. Dipa Pharmalab Intersains
PT. Etana Biotechnologies Indo
PT. Ethica Industri Farmasi
PT. Fresenius Kabi Indonesia
PT. FUTAMED
PT. Giri Sakti Utama
PT. Global Health
PT. Global Medika Inovasi
PT. idsMed Indonesia
PT. Mega Medica Pharmaceutical
PT. Nulab Pharmaceutical Indon
PT. PELITA BIOMEDICAL
PT. Pertiwi Agung
PT. Pharma Health Care
PT. Pharma Health Care
PT. Royal Medicalink Pharmalab
PT. Satya Abadi Pharma
PT. SOHO INDUSTRI PHARMASI
PT. Surgika Alkesindo
PT. Tempo Rx Farma
PT. Tripatria Andalan Medika
PT. Wellesta Cpi
PT. Zuellig Pharma
PT.PHARMALINK
PUSPA PHARMA
PYRIDAM
RAJAWALI
Respina
ROCHE INDONESIA
ROHTO LABS
ROI SURYA
ROYAL PHARMALAB
SANBE FARMA
SANDOZ
SANGHIANG PERKASA
SANKYO
SANOFI
SARI HUSADA
Sature
SCHERING
sddsd
Self registration
SERVIER INDONESIA
SIMEX
SOHO
SOLAS
SOLVAY
St.JUDE MEDICAL
STERLING
STIEFEL LABS
SUNTHI
SURYA DERMATO
TAKEDA
TANABE
TEGUHSINDO
Tempo Rx Farma
TEMPO SCAN PACIFIC
TIARA PERMATA SARI
TIRTATAMA NUSA
TRANSFARMA
TROPICA MAS
TUNGGAL IDAMAN
UBC
Undangan PDSKO
UNITED AMERICAN
Universitas Indonesia
VALEANT
VIFOR PHARMA
VITABIOTICS
vvip
WESTMONT
WIDATRA
World Holiday Tour & Travel
YAKULT
YAMANOUCHI
YARINDO
YUPHARIN
ZAMBON
PARTICIPANT
Foreign/Local Participant
Foreign Participant
Local Participant
Profession
Specialist ( A Member of One of the 18 Association Under RESPINA )
Specialist ( Others )
GP/Resident/Nurse
Student
Society
- Choose -
Indonesian Society of Respirology (PDPI)
Indonesia Association of Thoracic and Cardiovascular Surgeons (HBTKVI)
The Indonesian Society of Radiology (PDSRI)
Indonesian Neurological Association (PERDOSSI)
Indonesian Heart Association (PERKI)
The Indonesian Society of Anesthesiology and Intensive Therapy (PERDATIN)
The Indonesian of Physical Medicine and Rehabilitation Association (PERDOSRI)
Indonesian Pediatric Society (IDAI)
The Indonesia Otorhinolaryngological Head and Neck Surgery Society (PERHATI-KL)
Indonesian Association of Clinical Pathologist (PATKLIN)
The Indonesian Physician of Community Medicine and Public Health Association (PDK3MI)
Indonesian Sport Medicine Association (PDSKO)
Indonesian Society Clinical Microbiology (PAMKI)
Indonesian Association of Obstetrics and Gynecology (POGI)
Full Name
*
Match with "Pelataran Sehat" Account
Back Title
Full Name with Title
(Name will be printed on Certificate)
*
NIK/Identity Id
*
Address
*
Country
- Select One -
- OTHER -
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burma (Myanmar)
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Republic of the Congo
Democratic Republic of the Con
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Timor-Leste
Ecuador
Egypt
El Savador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Barthelemy
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadin
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
United Arab Emirates
Uganda
United Kingdom
Ukraine
Uruguay
United States
Uzbekistan
Vanuatu
Holy See (Vatican City)
Venezuela
Vietnam
US Virgin Islands
Wallis and Futuna
West Bank
Western Sahara
Yemen
Zambia
Zimbabwe
Cote D`Ivore
Myanmar
Korea
*
Province
- Select One -
- OTHER -
Bali
Bangka Belitung
Banten
Bengkulu
DI Yogyakarta
DKI Jakarta
Gorontalo
Jambi
Jawa Barat
Jawa Tengah
Jawa Timur
Kalimantan Barat
Kalimantan Selatan
Kalimantan Tengah
Kalimantan Timur
Kalimantan Utara
Kepulauan Riau
Lampung
Maluku
Maluku Utara
Nanggroe Aceh Darussalam (NAD)
Nusa Tenggara Barat (NTB)
Nusa Tenggara Timur (NTT)
Papua
Papua Barat
Riau
Sulawesi Barat
Sulawesi Selatan
Sulawesi Tengah
Sulawesi Tenggara
Sulawesi Utara
Sumatera Barat
Sumatera Selatan
Sumatera Utara
*
City/State
*
Mobile Phone
*
E-Mail
*
Match with "Pelataran Sehat" Account
Access Key
[generate automaticaly]
INSTITUTION
Name
Address
;tampilkanBasket(895648);
HOTEL RESERVATION
Hotel
- Choose One-
Shangri La Hotel
Room Rate
please select hotel first....
Room Count
1
Check in
26/08/2025
27/08/2025
28/08/2025
29/08/2025
30/08/2025
Check Out
27/08/2025
28/08/2025
29/08/2025
30/08/2025
31/08/2025
Total Night[s]
0
Disc.:
Rp. 0,-
Total Hotel Fee
0
Rp. 0,-
PAYMENT METHODS
Manual Transfer
Information Payment via Manual Transfer
Additional fee under IDR 1000 will be added as unique payment verificaton code
Bank Information
Bank BRI KK Sulianti Saroso Sunter
No. Acc : 1205.01.000014.30.9
C/O : RESPINA
Unique Payment Verification Codes,1,584,0,584,103
FEE SUMMARY
showInfoBayar3(1,895648,'registrasi');gantiProfesi(895648);;