INACORS Membership Application

Indonesian Cornea Society (INACORS) is part of Indonesian Society of Cataract and Refractive Surgery (INASCRS) and member of Indonesian Ophthalmologists Association (PERDAMI)

Benefits of INACORS Membership :

• Full membership in INACORS (3 Years)
• Reduced registration fees at INACORS Congresses/Meeting
• Access to Members Only Area on the INACORS Website
• Membership application subject to approval by Board of Officers
• Membership Certificate upon approval by the Board of Officers

Registration Form

Membership Package

Full Membership

IDR 500.000 / USD 37,59
For 3 years

Personal Information

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First Name *

Middle Name

Last/Family Name

Title* Prof.Dr.Prof.Dr.

Birth Date

Institution

Address*

Country*

State

City

Zip Code

Phone Number *

Fax Number

Email *

Academic & Experience

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Medical School

Residency

Year Completed

Ophthalmic Training

Highest Qualification

Year Completed

No. of Years in Ophthalmic Practice

Subspecialty Interest

Have you performed Cornea surgery?
Yes No

Estimate no. of operations

NRA Perdami & Password

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NRA Perdami*

Password * min. 8 characters

Confirm Password *

Payment Method

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Credit Card

Please Note : All payment with credit card will be added with 2.9% administration charge + Rp 2.000, VA/Bank Transfer will be added Rp 4.400 administration charge. QRIS and Gopay will be added 0.7% administration charge

Submit