The GRC Frontiers

Registration Form

    Title * First Name (as stated on Passport) * Last Name (as stated on passport) * Passport number *

    Birth date *

    Company / Institution * Position * Department / Division * Email 1 (Primary) * Email 2 (Alternative) Phone 1 (Primary) * Phone 2 (Alternative) Mailing Address (Street, City, Province, Country, Postal Code) * Contact Person (PIC) Detail (Email, Phone, Address) * Date period * Route * Package * Additional Request: Room - Single Supplement (1 room for 1 person) * Additional Request: Flight Tickets *
    Please select the flight class:
    Additional Request: Visa Handling * *Additional request may require additional fee Payment by Additional Note or Request (e.g. vegetarian) Participant with the data above is registering for this program.
    Note:
    *) is mandatory field
    **) can be readjusted at any time according to the recent price and flight ticket availability


    Cancellations made approaching the event will be charged administrative costs as follows: • After 12 July 2024: 75% charge of full payment • After 16 August 2024: 100% charge of full payment
    Need Help?

    Send us an email at secretariat@crmsindonesia.org
    or reach us through WhatsApp.

    Need more info?