Registration

Please fill out the form below according to your National Identity Card or Passport. The data you provide will be kept confidential.

Guarantee for participants age less than 18 years

I hereby declare that I, in accordance with the data stated above, GIVE MY CONSENT acting as the parent or guardian of
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PT. INDO MEDIZEN SEHAT

Plaza Mutiara 15th Floor
Jl. Dr. Ide Anak Agung Gde Agung
Mega Kuningan, Jakarta 12950

Phone: +62 21 5092 7373

Operational Hours:
Monday - Friday
08.00 - 17.00 WIB