Full Name: (required) (as it should be appeared in the certificate)

University/Institution: (required)

City/Regency of Institution: (required)

Country: (required)

e-mail: (required) (will not be displayed to public)

Cellphone / WhatsApp number: (required) (will not be displayed to public)

Alternative cellphone / WhatsApp number: (optional, will not be displayed to public)

Category: (required) General Graduate Student (S2, S3) Undergraduate Student (S1) MDSM (Malaysia) Dean MIPAnet Dean MIPAnet Vice Dean MIPAnet Head of Department MIPAnet Head of Study Program

Profile: (required) Contributed Speaker (Presenter, will present a paper) Non-contributed Speaker (Attendant, will not present a paper)

Presentation: (required) On-site Live (at Discovery Kartika Plaza Hotel, Kuta, Bali) On-site by Pre-recorded Video (Duration at most 7 minutes) Online (Zoom) Live Online (Zoom) by Pre-recorded Video (Duration at most 7 minutes) No Presentation But Will Join at Discovery Kartika Plaza Hotel No Presentation. Will Join Online (Zoom)

On-site Free Workshop "Optimization Using Graphs" for Participants by Yokohama National University, Japan: (required) The number of participants for this workshop has reached the capacity.

On-site Free Workshop "Arduino-based Experiments in Science Education Research" for Participants by Prince of Songkla University, Thailand: The number of participants for this workshop has reached the capacity.

Bali Tour (See schedule here) : (please choose)

Tour 2 June 2022. Cost IDR. 370.000:    Registration for this tour is closed

Tour 4 June 2022. Cost IDR. 470.000:    Registration for this tour is closed

Tour 5 June 2022. Cost IDR. 250.000:    Registration for this tour is closed

Address: (optional, will not be displayed to public)