Author Agreement Form: 8 APPEN Conference 2 HPC Conference

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Committee of

The 2019 International Joint Symposium


8th APPEN Conference
(Asia Pacific Pharmacy Education Network)
2nd HPC Conference
(Halal Pharmaceutical & Cosmetics)

AUTHOR AGREEMENT FORM

Name :
Affiliation :
Institution :
Country :
Phone Number :
E-mail :
As the single author or one of the authors that represent all authors for The 8th Asia Pacific
Pharmaceutical Education Network (APPEN) Conference and the 2 nd Halal Pharmaceuticals and
Cosmetics Conference paper as follows:
Paper Title :
Corresponding Author :
Co-Authors (Author :

ABSTRACT ID : ……

I understand and agree that:

1. I give my consent to the 8th Asia Pacific Pharmacy Education Network (APPEN) Conference and
the 2nd Halal Pharmaceuticals and Cosmetics (HPC) Conference for the paper with the title mentioned
above, to be subsequently published as regular or special issue in international journals namely:
…………………………………....................................................................................................
2. I am willing to bear the costs of the journal publication determined by the journal publisher;
3. I warrant that the article with the title mentioned above is an original work that has not been
previously published and is free from plagiarism and infringement of the copyrights of others;
4. I guarantee that each of the names listed as the authors of the article with the title as mentioned above
grant the approval of the article publication and have given approval of the inclusion of his name in the
article;
5. I guarantee that the paper has not been published or not currently being considered for publication in
another journal and will not be submitted for another journal review;
6. I respect and follow the rules of the 8th Asia Pacific Pharmacy Education Network (APPEN)
Conference and the 2nd Halal Pharmaceuticals and Cosmetics (HPC) Conference committee related
to the publication process;
7. I am willing to give my response actively to the committee in support of the peer review process;
8. I give my consent that the committee will not be responsible for the author who is not active in
responding to the instructions from the committee regarding the peer review process;
9. I guarantee not to sue or blame the the 8th Asia Pacific Pharmacy Education Network (APPEN)
Conference and the 2nd Halal Pharmaceuticals and Cosmetics (HPC) Conference committee on legal
issue which may arise in the future and from third-party demands upon the publication of my article;
10. I state that I will not sue the 8th Asia Pacific Pharmacy Education Network (APPEN) Conference
and the 2nd Halal Pharmaceuticals and Cosmetics (HPC) Conference committee, if at any time the
publisher of the targeted journal is not indexed in Scopus, SCIE, PubMed, CPCI, Web of Science, and
others;
11. I state that I will not withdraw my article after signing this agreement form;
12. The final decision of the publication depends on the journal, not on the committee.

Thus, this statement is made in a conscious state without any element of coercion from other parties.

Name: Signature: Date:

Secretariat:
Faculty of Pharmacy Universitas Airlangga, Phone +6231 5933150 Email : appen-secretariat@ff.unair.ac.id
Gedung Nanizar Zaman Joenoes, Campus C – Mulyorejo, Fax. +6231 5932549 Website : http://ff.unair.ac.id/appen2019
Surabaya 60115, Indonesia

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