JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
FORMULIR PENDAFTARAN
WORKSHOP MEMBANGUN BUDAYA KESELAMTAN PASIEN : PENGUKURAN, MONITORING DAN EVALUASI
DI FASILITAS PELAYANAN KESEHATAN”
(Langkah 1 dari Tujuh Langkah Keselamatan Pasien)
HOTEL SANTIKA PREMIERE SLIPI JAKARTA TANGGAL 1 - 2 FEBRUARI 2024
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Nama Peserta (untuk Sertifikat)
*
Your answer
Jenis kelamin
*
Your answer
Instansi / RS
*
Your answer
Jabatan
*
Your answer
Provinsi / Kota
*
Your answer
Alamat E-mail Peserta
*
Your answer
Hp (WhatsApp)
*
Your answer
Biaya Investasi per Peserta Offline
*
Peserta Offline : Rp. 3.000.000,-
Bapak /Ibu...Setelah klik Submit/kirim , akan muncul link wag peserta mohon di klik linknya untuk bergabung dalam wa group peserta. Terima kasih.
Your answer
Bapak /Ibu...jika ingin menginap di hotel Santika Premiere Slipi Jakarta silakan mengisi formulir pemesanan hotel melalui link sbb :
https://bit.ly/FormHotel-WSBudayaKP-2024
Terima kasih.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms