Seminar Registration Form
Contact Person: Ibu Nancy Saskiawati, Sekretariat PAI
Tel: (62) 21 8355105 or mobile phone 0816917477,Email to:[email protected] Personal Particulars
No Name (Mr./ Mrs./ Ms./ Dr/ Prof) Title Membership *) Seminar Fee
1. Rp.
*) Please write membership status: PAI and Registration Number or SOA or non-member
Contact Person: _________________________________________________________________________________ Company Name: _________________________________________________________________________________ Company address:________________________________________________________________________________ ________________________________________________________________________________________________ Tel: ( )__________________________Mobile: ( )___________________________________________ Fax ( )___________________________ Email: __________________________________________________
□ PAI/ SOAmember: Rp 1,750,000 *) □ PAI/ SOA member: Rp 2,000,000 *) □ Non-Member: Rp. 2.000.000 □ Non-Member: Rp. 2.250.000
Full registration fees MUST be paid before the valid dates for admittance at seminar. Only registrations FULLY PAID FOR by the early-bird deadline will be eligible for the discount. *) PAI members who have paid annual PAI membership fee.
Payment:
Transfer to the following account: Bank MandiricabangTebet Raya
PersatuanAktuaris Indonesia (PAI),Rekening number:124-00-0519311-6
