The 18th International Symposium of Indonesian Inter University

Transport Studies Forum (FSTPT)

Civil Engineering Department - University of Lampung

Jl. Sumantri Brojonegoro No.1 Bandar Lampung Telp./Fax. (0721) 704947
Website: fstpt.unila.ac.id

REGISTRATION FORM
1.

Full Name

2.

Institution

3.

4.

WILLY KRISWARDHANA

Author
Presenter
Author not
as Presenter

a.

University

UNIVERSITY OF JEMBER

b.

Faculty

FACULTY OF ENGINEERING

c.

Department

DEPARTMENT OF CIVIL ENGINEERING

d.

Address of Institution

JL. KALIMANTAN NO. 37

e.

City

JEMBER

f.

Phone Number

g.

Status

General
Participant

Facsimile Number
S1

S2

S3

X Lecture

Others

Put cross mark "X" in the

box with appropriate
choice.

:
Put cross mark "X" in the box
with appropriate choice.

Personal Contact
a.

Mobile Phone

086749350356

b.

E-mail

willy.kriswardhana@yahoo.com

August 28, 2015

Register as Symposium

or

Put cross mark "X" in

the box with
appropriate choice for
registration, and fill in
symposium fee on the
right.

5.

Register as Workshop
a.

FSTPT Member (Student)

Rp.

FSTPT Member (Lecturer)

Rp.

Non FSTPT Member

(Student)

Rp.

Non FSTPT Member

(Lecturer)

Rp.

Local Participant

Rp.

International Participant

Rp.

Workshop - August 27, 2015

parallel sessions workshop from 13.00 - 15.00 WIB
Session 1 (13.00-15.00)
1)

Workshop Penyusunan Indikator Kinerja

Utama (IKU) Penyelenggaraan Transportasi
Berkelanjutan: Prof. Dr. Ir. Agus Taufik
Mulyono

Session 1 Workshop 1

Rp.

2)

Workshop Optimalisasi design perkerasan

Session 1 Workshop 2

Rp.

400.000,-

jalan raya terhadap dampak deformasi

permanen pada umur pelayanan jalan: Ir.
Mulyadi Irsan, MT.
3)

Workshop Peran Transportasi dalam ICM

(Integrated Coastal Management) Prof . Dr. Ir.
Rokhmin Dahuri, MS

Paralel Session Workshop from 15.00-17.00 WIB

4) Workshop Transportasi dan Logistik: Lingkup,
Indikator Kinerja dan Ketidakpastian: Dr. Bona
Frazila, M.Sc.
5) Workshop Konsep Analisis Jaringan
Transportasi: Dr. Hitapriya Suprayitno
6)

6.

Workshop Pengembangan Safe System untuk

Jalan Berkeselamatan: Ir. Tri Tjahjono, M.Sc,
Ph.D

Session 1 Workshop 3

Rp.

Session 2 Workshop 4

Rp.
Rp.

Session 2 Workshop 5

Rp.

250.000,-

Session 2 Workshop 6

X Governor of Lampung

Register as FSTPT Gala Dinner

Free for FSTPT member. Fill with "X" to register.

7.

Register as FSTPT Annual Member Meeting

FSTPT Annual Member Meeting

Free for FSTPT member. Fill with "X"

to register.

8.

Register as FSTPT-18 Field Trip, max 100 pax each

X
a.

Field trip at Krakatau Tour

Krakatao Tour Shirt

b.

Field trip at Pulau Pahawang

Beach Shirt

Ship and down to krakatau

R
p.

(S, M, L, XL) size

R
p.

Beach Spot

R
p.

(S, M, L, XL) size

R
p.

X
c.

Rp. 1.250.000,-

has been paid to :

Bank Name

BNI KCP Unila

Account Name

CITRA DEWI

Swift Code

BNIFT LPG

Account Number

036-828-0444

The total amount of

ADDITIONAL REQUEST
a.

b.

c.

d.

I want joint Shuttle from Airport to Bandar Lampung . (write your arrival time)

Thursday, August 27, 2015

Friday, August 28, 2015

10.30

WIB

.................WIB

I want joint Shuttle from Rail Station to Bandar Lampung . (write your arrival time)

Thursday, August 27, 2015

.................WIB

Friday, August 28, 2015

.................WIB

I want joint Shuttle from Rajabasa Terminal to Bandar Lampung . (write your arrival
time)

Thursday, August 27, 2015

.................WIB

Friday, August 28, 2015

.................WIB

I want joint Shuttle from Bandar Lampung to Airport (write your departure time)

200.000,-

R
p.

(S, M, L, XL) size

Tapis Shirt

9.

R
p.

Field trip at Tapis Carnival

400.000,-

Saturday, August 29, 2015

.................WIB


e.

f.

h.

Signature :

Sunday, August 30, 2015

17.00

WIB

I want joint Shuttle from Bandar Lampung to Rail Station (write your departure time)

Saturday, August 29, 2015

.................WIB

Sunday, August 30, 2015

.................WIB

I want joint Shuttle from Bandar Lampung to Rajabasa Terminal (write your departure
time)

Saturday, August 29, 2015

.................WIB

Sunday, August 30, 2015

.................WIB

I want the Organizing Committee to book hotel.

1)

Hotel name

2)

Check in date

3)

Check out date

4)

Share room with other participants

YES

Date

13/8-2015

NO

ANNOTATION :
1.

2.

Once completed, please send the following to fstpt@eng.unila.ac.id

a.

This Symposium Registration Form.

b.

Scan of proof of payment

The registration fee of symposium are as follows :

WORKSHOP
August 27, 2015

SYMPOSIUM
August 28, 2015

1.

FSTPT Member (Student)

IDR

200.000,-

IDR

300.000,-

2.

FSTPT Member (Lecturer)

IDR

250.000,-

IDR

400.000,-

3.

Non FSTPT Member (Student)

IDR

250.000,-

IDR

400.000,-

4.

Non FSTPT Member (Lecturer)

IDR

300.000,-

IDR

600.000,-

5.

Local Participant

IDR

300.000,-

IDR

750.000,-

6.

International Participant

US$

300

US$

350

3.

The registration fee of FSTPT Gala Dinner and Annual Member Meeting is FREE

4.

The registration fee of FSTPT-17 Field Trip are as follows :

a.
b.
c.

Field trip at Krakatau Tour

IDR

400.000,-

Krakatao Tour Shirt

IDR

150.000,-

Field trip at Pulau Pahawang

IDR

400.000,-

Beach Shirt

IDR

150.000,-

Field trip at Tapis Carnival

IDR

200.000,-

Tapis Shirt

IDR

150.000,-

Itinerary and details of program, also accommodation (hotels) shown at FSTPT Website. Participant who
followed workshop, symposium and field trip will get special seminar kit such as laptop bag.