FORM REGISTRASI - HMA Connect Series
Jakarta, JS Luwansa Hotel, 6-7 July 2022 (with hospital innovation tour during breaks)

* Only fully vaccinated attendees will be allowed entry to the event.
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First Name *
Last Name *
Email *
Phone *
Country *
Complete Address *
Organization/Institution *
Job Title
My Organization/Institution is *
What is the number of beds at your facility? *
Please select your role/job function *
Please select your job level
Tick all the digital tools your hospital or clinic uses (can choose more than one options) *
Required
What are your objectives for attending the event (can choose more than one options) *
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What are the top 3 challenges that keep you from achieving your goals in your current role?
Are you interested to join the Hospital innovation tour? *
A 30-minute tour showing the latest healthcare technology solutions for hospitals with focus on clinical fields (such as cardiology, oncology, neurology, etc.) with the command center at the heart showing how these can be interconnected in improving patient experience and health outcomes. Slots are available during the breaks on 6-7 July. Venue will be at the same hotel in JS Luwansa, Jakarta. Each time slot is limited to 20 participants only.
Sign me up for the Hospital Management Asia community, a weekly newsletter on the latest healthcare insights in Asia (I may unsubscribe at any time after the first email is sent) *
I am fully vaccinated againts COVID-19 (at least 3 shots including booster) *
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I agree to the Event Privacy Notice and Privacy Policy (required to click both) *
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