2017 5th International Conference on Information and Network Security (ICINS 2017)

Registration form of ICINS 2017

December 5-7, 2017 Jakarta, Indonesia.

2017 5th International Conference on Information and Network Security （ICINS 2017）

NOTE: To avoid delays in registration, please read the entire form carefully. You may submit your completed Registration Form and the Scanned Payment of the applicable registration fee to before November 25th, 2017. Please submit one form for each participant.

Participant Information (中国作者请用中文填写, 以方便邮寄)

* Compulsory items.

*First Name: / *Family Name:
Title: (Prof., Assistant Prof., Dr, Mr. Ms. etc.) / Male □ Female □
*Will you attend the conference in person?
Yes □ No □
* The participant’s name (If yes):
* participant’s Affiliation(Organization or University): / One-inch-Photo here
(*please take a photo to the conference if you didn’t put one here)
* Research interest:
**Mailing Address:
*City: / *State/Province:
*Country: / *ZIP/Post Code:
*Tel.: / *E-mail: / Fax:
Student ID Number:
Research Fields:
Special dietary:
Diabetic □ Vegetarian □ Muslim □ Other □ (please specify: )
Physical requirements (if any):

Conference Fees (by US Dollar) ***

Registration Fee
(International Delegates) / Registration Fee
(Indonesian Delegates) / Mark Your Choice
Professionals
Listeners / 250 USD / 150 USD
Students
Listeners / 200 USD / 150 USD
Professionals & Students
Excursion Program / 60 USD / Person / 50 USD / Person

Notes:
* Listener: Participating in the conference only without neither presentation nor paper publication.
* Accompanying person needs to register as a listener to attend the conference.
* Please note that the paid registration fee cannot be refund if you cannot participate in the conference

Payment Terms

  1. Payment by credit cards.
    Credit Card Payment Information

PAYING METHOD (No service charge)

Please make sure you have VISA or Mastered Card Credit Card before clicking this link, and you should also calculate the right amount and pay.

Please fill in the E-mail and Confirmation Number after paying.

  1. E-mail:
/
  1. Order Number:

  1. Registration fee can be paid to the Organizing Committee through bank transfer. If you can not pay with credit card, you can pay through bank. Our bank information is as following:

Bank Name : DBS BANK, Singapore

Bank Address : 6 Shenton Way, DBS Building Singapore 068809

Name of Account : International Association of Computer Science & Info Tech

Beneficiary’s Address: 9 Jurong Town Hall Road iHub #02-76, Singapore 609431

Account Number : 054-902037-0

BIC/SWIFT Code : DBSSSGSG

Please fill in the following form for us to check your payment

Remitter’s A/C No.
Remitter’s Name:
Remit date:
Remit amount:

Note:

  1. Payment by Method 1 is priority to accept.
  2. Bank service charges should be paid by the payer.
  3. If pay by method 2, please pay 30 USD more, for the service charge.
  4. Registration can only be secured and confirmed when payment has been received.

Listener Registration Fee Includes:

1) Coffee break, Lunch & Dinner on the conference day

2) Conference materials

3) Participation in the Technical Program

4) Certificate of Participation

Gentle Remind:

After the payment, please send all required materials to the conference mailbox, only after receiving the feedback from conference mailbox () the registration can be considered successful, if no any feedback within three work days, please contact via email or telephone again.

Thanks for your time, PLEASE RETURN the Registration Form, and the Scanned payment proof to (Before November 25th, 2017)

ICINS2017 Organizing Committees

Jakarta, Indonesia