PIR Kaltim: REGISTRATION

R e g i s t r a t i o n

We are very please to welcome you join PIR Kaltim 2017.

1. Please fill in REGISTRATION FORM next to this page

2. Please made your registration payment to:

BANK SYARIAH MANDIRI

KCP BALIKPAPAN BARU

c/o. Perhimpunan Dokter Paru Indonesia

Acc No. 68 888 999 93

3. Confirming your payment by sending registration form and copy of bank transfer by fax, postal or email with attention to:

Ms Ella or Ms Widi or Marissa, MD

Pulmonary Clinic

Kanujoso Djatiwibowo Hospital

Address: MT Haryono 656, Balikpapan 76126

Phone: +62-542-873-901 ext 1114

Mobile phone:

· Ella +62-8125-4730-602

· Widi +62-8522-5009-444

· Marissa +62-8138-6700-771

Fax: +62-542-873-836

Registration: DOWNLOAD

PIR Kaltim