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The 1st International Conference on Marine Technology (SENTA)

December 15-16th, 2016


Surabaya, Indonesia

REGISTRATION FORM
Yes, I am interested in (please check):
Presenting papers
Attending the conference
Sponsoring the exhibition
Title (please check):
Prof.

Dr.

Mr.

Mrs.

Family Name

Given Name

Position

Organization/Company

Address

City

Country

Phone (Include country code)

Mobile Phone

Fax

Email

Ms.

Please return this form by email to the 1st SENTA 2016 Committee
(senta@its.ac.id).

The 1st International Conference on Marine Technology (SENTA)


December 15-16th, 2016
Surabaya, Indonesia

PRESENTERS BIODATA
Paper Number
Paper Title
Author(s)
Name of Presenter

Affiliation/Department/Firm/Organization/Institute:
1.
2.

Academic Background:

Brief Work Experience/Professional Background:

Brief Description of Paper (2-3 sentences):

Others :

Please return this form by email to the 1st SENTA 2016 Committee
(senta@its.ac.id).

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