INASCRS Membership Application



Membership Package

Full Membership

IDR 1.500.000 / USD 113,64
For 3 years (include APACRS membership fee)

Associate Membership

IDR 1.000.000 / USD 75,76
For 3 years (only INASCRS membership fee)

currency : USD 1 = IDR 13.200
Personal Information
NRA-PERDAMI NO.*:
Title*:
First Name *:
Middle Name:
Last/Family Name:
Institution:
Address*:
Country*:
State:
City:
Zip Code:
Phone Number *:
Fax Number:
Email *:
Birth Date:
Medical School:
Residency:
Year Completed:
Ophthalmic Training:
Highest Qualification:
Year Completed:
No. of Years in Ophthalmic Practice:
Subspecialty Interest:
Have you performed intraocular implant surgery?: Yes No
If Yes, estimate no. of operations:
Have you performed refractive surgery?: Yes No
If Yes, estimate no. of operations:

Website Login Information
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Payment Method

Bank Transfer To : Bank Mandiri
122-000-60921-86 - INASCRS Foundation