SUBSCRIPTION FORM

I/We wish to subscribe “Jurnal Farmasi Sains dan Komunitas (Journal of Pharmaceutical Sciences and
Community)” and agree to abide by your rules and regulations.

Subscriber Details:

Name ....................................................................................................................................
Institution ....................................................................................................................................
Address ....................................................................................................................................

....................................................................................................................................
City ……………………………………………………………….. Country………………………………………………………………
State / Province ……………………………………………. Zip / Postal Code ……………………………………………..
Telp. / Mobile ……………………………………………………………………….. Fax: …………………………………………………………………
Email ....................................................................................................................................

Subscription Rates:
Subscription Rates*
Indonesia (local) International
Annual (2 issues/year) Rp 200.000,00 USD 14.00
Per Issue/Number Rp 100.000,00 USD 7.00
*All rates excludes 30% shipping charge

Subscription Details:
Annual Subscription Per Issue/Number Subscription

From year ……………. to ……………. Volume ………………….. No. …………………..

Number of copies ……………………….. Number of copies ………………………..

Notes: Date:

Signature:

Order and Payment Method:

All orders for hardcopy of the journal may be sent via email to editorial.jpsc@usd.ac.id with the subject Order
Journal. After receiving invoice details from the subscription managers, all payments should be made via transfer
to CIMB Niaga (Account holder: Lembaga Penelitian Univ. Sanata Dharma, Account Nr. 800077540800).
The order will be executed when payment has been made and the proof of payment has been scanned and sent
accordingly.

Please mail this subscription order form to:

Dina Christin Ayuning Putri (Subscription Manager)
Jurnal Farmasi Sains dan Komunitas (Journal of Pharmaceutical Sciences and Community)
Telp +62 85729333155
email: editorial.jpsc@usd.ac.id / dinachristin@usd.ac.id