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The 9th National Conference & 14th Annual Scientific Meeting Of Indonesian
Physical Medicine & Rehabilitation Association (MUKERNAS IX & PIT XIV
PERDOSRI)
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Facing The Challenge of Disability Through PMR in 21 st Centuries
October, 7th 10th 2015, Discovery Hotel & Convention Ancol, Jakarta Indonesia
REGISTRATION & ACCOMODATION FORM
PLEASE FILL IN THIS FORM WITH CAPITAL BLOCK LETTERS

Title : Medical Doctor

First Name : Sekar
Last Name : Ciptaningrum
Institution :
Address : Reni Jaya blok e7/7
City : Depok
Province : West Java
Country : Indonesia
Postal Code : 16517
Email : moeza.cat@gmail.com
Mobile : 0817-0946403
Phone :
Symposium Category (GP/Specialist) : GP
Workshop Option(s):

Registration Fee

Symposium Category Up to 31 August 2015 After Onsite

31 August 30 Sept 2015

GP/Resident Rp. 1.250.000,- Rp. 1.500.000 Rp. 2.000.000

Specialist Rp. 2.000.000,- Rp. 2.500.000 Rp. 3.000.000

Registration Fee

Workshop Up to 31 August After

2015 31 August 30 Sept
2015
Friday, 9th October 2015 (08.00-17.00 WIB) Full day
 Workshop 1: To Be An Expert in Rp2.000.000,- Rp2.500.000,-
Osteoporosis Rehabilitation Management
Workshop 2 : USG Musculosceletal For Rp2.000.000,- Rp2.500.000,-
Peripheral Nerve Spine and Hip
Workshop 3 : Rehabilitation Post ACL Repaired Rp2.000.000,- Rp2.500.000,-
and Its Problem
Workshop 4 : Dysphoni Rp2.000.000,- Rp2.500.000,-
Workshop 5 : Rehabilitation Management in ICU Rp2.000.000,- Rp2.500.000,-
Workshop 7 : Dysphagia Rp2.000.000,- Rp2.500.000,-
Workshop 9 : Gait Analysis Rp2.000.000,- Rp2.500.000,-
Workshop 15 : ICF / Pain (tentative) Rp2.000.000,- Rp2.500.000,-
Workshop 16 : Neurogenic Bladder Rp2.000.000,- Rp2.500.000,-

Saturday, 10th October 2015 (08.00 17.00 WIB) Full day

Workshop 6 : Pulmonary Rp2.000.000,- Rp2.500.000,-
Rehabilitation For Asthma &
COPD
Workshop 8 : Exercise Rp2.000.000,- Rp2.500.000,-
Prescription for Disability
Workshop 10 : Feeding Rp2.000.000,- Rp2.500.000,-
Workshop 12 : Intra Articular Rp2.500.000,- Rp3.000.000,-
Injection (HandsOn)
Photography Class Free

Saturday, 10th October 2015 (08.00 12.00 WIB) Half day

Workshop 13 : ESWT Rp1.250.000,- Rp1.500.000,-
Saturday, 10th October 2015 (13.00 17.00 WIB) Half day
Workshop 14: Update Physical Medicine and Rehabilitation Rp1.250.000,- Rp1.500.000,-
Management in Plexus Brachial Injury

Workshop for General Practioners Up to 31 August After

2015 31 August 30 Sept
2015
Saturday, 10th October 2015 (08.00 12.00) Half day
Pemeriksaan Dasar Kedokteran Fisik dan Rp1.250.000,- Rp1.500.000,-
Rehabilitasi untuk Dokter Umum

ACCOMMODATION FEE

Discovery Hotel & Convention Ancol, PRICE CHECK CHECK TOTAL

Jakarta IN OUT NIGHT
 Deluxe Rp.
1.100.000,-
Superior Rp.
1.000.000,

PAYMENT METHODS

o Transfer via following account:

Bank : BRI
Address : Panglima Polim
Account name : PT CIPTA DELIMA INDONESIA
Account number : 0420. 01. 000426. 30. 7

or

Bank : BRI
Address : Tambun
Account name : PB PERDOSRI
Account number : 0444. 01. 000420. 30. 3

Bank charges will be borne by participants

Please email this form to reg_pit_14_perdosri@yahoo.com