FINAL ANNOUNCEMENT Revised

INDONESIAN PEDIATRIC SOCIETY (Ikatan Dokter Anak Indonesia) PEDIATRIC CRITICAL CARE WORKING GROUP

proudly present and organized

Discovery Kartika Plaza Kuta - Bali Saturday -Tuesday, 15 - 16, 17 18 October 2011
discovery room, discovery Kartika plaza Bali thursday - Friday, 13 14 October 2011

PRE-SYMPOSIUM COURSE PEDIATRIC FCCS

For further information, kindly contact Ms. Ade Syariah 021.68599155

4th INDONESIAN PICU NICU Update & EXHIBITION POST SYMPOSIUM WORKSHOPS
Ventilatory support praCtiCe For CliniCal appliCations in piCu niCu (For Physicians Only) ManageMent oF pediatriC sHoCK in piCu (For Physicians Only) perioperatiVe ManageMent in neonatal unit (For Physicians Only)

saturday sunday, 15 16 October 2011

Monday tuesday, 17 18 October 2011

Message from the Chairman

Dear Colleagues, On behalf of the Organizing Committee, it gives us immense pleasure and honor to extend invitation to you all for the 4th INDONESIAN PICU-NICU UPDATE to be held on 15-16, 17 18 October 2011. The meeting will be packed with some favorite Workshops post the conference on 17 - 18 October 2011. This annual scientific meeting showcases our commitment to the clinicians and professionals in the care of critically ill children and neonates due to promote and share the common goal through every new dimension of learning experience, research, and care - where European and Asia Pacific expert faculties will share their extensive knowledge, encourage thought-provoking discussions and guide problem-solving. Attend the meeting in the Goddess Island, offering participants the opportunity to share knowledge and attend a well established and successful annual meeting, as well as the added benefit of being a part of a exotic experience in Bali. We do hope that the participants experience the satisfaction that the care you provide will make a difference in your patients outcome. So please set aside these dates in your diary for what we trust will be a great opportunity to all of us. Best wishes, Chairman,

Abdul Latief, dr, SpA K

Organizing Committee
STEERING
I Wayan Bikin Suryawan, dr, SpA K Ketua IDAI Cabang Bali Bagus Ngurah Putu Arhana, dr, SpA K Ka. SMF/Lab IKA FK. Universitas Udayana, RSUP. Sanglah Bali

SECRETARY

Rismala Dewi, dr, SpA K

SCIENTIFIC COMMITTEE

CHAIRMAN

Abdul Latief, dr, SpA K

CO-CHAIRMAN

Antonius H. Pudjiadi, dr, SpA K Rinawati Rohsiswatmo, dr, SpA K Ririe Fachrina Malisie, dr, SpA K Risma K. Kaban, dr, SpA Lili Runjan, dr, SpA I Made Kardana, SpA

Ida Bagus Gede Suparyatha, dr, SpA

General Information
EVENT PLACE
4th INDONESIAN PICU-NICU UPDATE

Discovery Kartika Plaza, Kuta - Bali

AGENDA

Saturday - Sunday, 15 16 October 2011: 4th Indonesian PICU NICU Update Symposium & Exhibition

Monday Tuesday, 17 18 October 2011: Post Symposium Workshops VENTILATORY SUPPORT PRACTICE FOR CLINICAL APPLICATIONS IN PICU NICU (For Physicians Only) MANAGEMENT OF PEDIATRIC SHOCK IN PICU (For Physicians Only) PERIOPERATIVE MANAGEMENT IN NICU (For Physicians Only)

REGISTRATION SECRETARIAT & MAILING ADDRESS

Pediatric Critical Care Working Group - Indonesian Pediatric Society (Ikatan Dokter Anak Indonesia) has chosen a cooperate organizer, who will ensure a smooth and efficient management of the scientific exhibition, hotel accommodation, registration management and other programs linked to 4th Indonesian PICU NICU Update. For any further information about these services, do not hesitate to contact the Secretariat & Mailing Address : c/o. Global Echo Organizer convex Email : info@geoconvex.com Homepage : www.geoconvex.com Registration & Accommodation: Tel: 021.3149318 - 19 | Mobile: 0811.882080 | Fax To: 021.3153392

EXHIBITION

4th Indonesian PICU NICU Update will host a scientific exhibition on 15 - 16 October 2011 including the latest technology, equipment for clinical management & research and literature.

POST SYMPOSIUM WORKSHOPS

To emphasize the importance of this essential part of its 4th Indonesian PICU-NICU Update will organize intractable two full days workshops, which consist of scientific lectures, case studies and/or hands-on special design courses, as its post-symposium workshop programs. The program will be held on Monday Tuesday, 17 - 18 October 2011. See detail schedule.

OFFICIAL LANGUAGE

The official language of 4th Indonesian PICU NICU Update are both in English and Indonesian. It will be used for all printed materials, presentation and discussions. Any simultaneous translation will not be provided.

DISCLAIMER

Every attempt will be made to present the program as printed. However, Organizers and its agent reserve the right to alter or cancel, without prior notice, any of the arrangements, timetables, plans or other items relating directly or indirectly to the Scientific Meeting, for any cause beyond its reasonable control. In the event of cancellation of the Scientific Meeting, all pre-paid fees will be refunded in full. The Organizers and its agent are not liable for any loss or inconvenience caused as a result of such alteration and cancellation.

Post Symposium Workshops

Post Symposium Workshop Certificate with IDI Accreditation & SKP IDAI will be issued for all workshop participants. We strongly suggest that Post Symposium Workshop participants should be registered as a participant in terms of its scientific activities. Each workshop participant is limited to approximately 60. Post Symposium Workshops, conducted by experts of Pediatric and Neonates will update participants on the current state-of-art on developing participants skill and technique in management of Pediatric & Neonates critically ill patients. Please acknowledge that Workshop participants are strictly limited. Payment made for over reserved might be reimbursed to the payer bank account in this special case.

Agenda
ROOM Kharisma Ballroom DATE 17 & 18 October 2011 WORKSHOP NAME VENTILATORY SUPPORT PRACTICE FOR CLINICAL APPLICATIONS IN PICU NICU (For Physicians Only) MANAGEMENT OF PEDIATRIC SHOCK IN PICU
(For Physicians Only)

Rama-Shinta

17 & 18 October 2011

Discovery

17 October 2011

PERIOPERATIVE MANAGEMENT IN NEONATAL UNIT

(For Physicians Only)

VENTILATORY SUPPORT PRACTICE FOR CLINICAL APPLICATIONS IN PICU NICU (For Physicians Only)

MONDAY TUESDAY, 17 - 18 OCTOBER 2011 KHARISMA BALLROOM , Discovery Kartika Plaza, Kuta BALI Workshop Director: Abdul Latief, dr, SpA K DAY 1 - MONDAY, 17 OCTOBER 2011 TIME 08.00-08.10 Introduction 08.10-08.40 Pre-Test 08.40-09.10 Basic Mechanical Ventilator 09.10-09.40 Ventilator Graphics 09.40-10.10 Mode of Ventilation 10.10-10.30 Coffee/Tea break 10.30-11.00 Initiating and Adjusting 11.30-12.00 Weaning Mode 12.00-13.00 Lunch SKILL STATIONS 1 13.00 - 13.45 A. Ventilator Graphics 13.45 - 14.30 B. Initiating and Adjusting
Abdul Latief, dr, SpA (K) Ririe Fachrina Malisie, dr, SpA (K) Antonius H. Pudjiadi, dr, SpA (K) Ririe Fachrina Malisie, dr, SpA (K) Abdul Latief, dr, SpA (K) Abdul Latief, dr, SpA (K) Ririe Fachrina Malisie, dr, SpA (K)

PROGRAM

INSTRUCTOR
Abdul Latief, dr, SpA (K)

11.00-11.30 Monitoring of Patient on Mechanical Ventilation G. Dharma Mulyo, dr, SpA (K)
Antonius H. Pudjiadi, dr, SpA (K)

14.30 - 15.15 C. Monitoring Patient on Mechanical Ventilation G. Dharma Mulyo, dr, SpA (K) 15.15 - 15.30 Coffee/Tea Break DAY 2 - TUESDAY, 18 OCTOBER 2011 TIME 08.00-08.30 08.30-09.00 09.00-09.20 PROGRAM Lung Protective Strategy Lung Recruitment Coffee/Tea break
[Divided into 5 GROUPS @ with 2 MV - Rotated @ 45]

INSTRUCTOR Ririe Fachrina Malisie, dr, SpA (K) Ririe Fachrina Malisie, dr, SpA (K)

SKILL STATIONS 2 09.20 - 10.05 A. Bronchopneumonia & ARDS 10.05 - 10.50 B. Apnea of Prematurity 10.50 - 11.35 C. Meconeum Aspiration Syndrome 11.35 - 12.30 Lunch SKILL STATIONS 2 - continue 12.30 - 13.15 D. Cardiopulmonary Interaction 13.15 - 14.00 E. Lung Recruitment 14.00 - 14.30 Post-Test 14.30-15.00 Coffee/Tea Break Ririe Fachrina Malisie, dr, SpA (K) 15.00 - 15.15 Evaluation & Certification G. Dharma Mulyo, dr, SpA (K) Riri Fachrina Malisie, dr, SpA (K) Abdul Latief, dr, SpA (K) Risma K. Kaban, dr, SpA (K) Lily Rundjan, dr, SpA (K)

MANAGEMENT OF PEDIATRIC SHOCK IN PICU

(For Physicians Only)

MONDAY TUESDAY, 17 - 18 OCTOBER 2011 RAMA SHINTA ROOMS , Discovery Kartika Plaza, Kuta BALI Workshop Director: Antonius H. Pudjiadi, dr, SpA K Workshop Co-Director: Rubiana Sukardi, dr, SpA K

DAY 1 - MONDAY, 17 OCTOBER 2011 TIME 08.00 - 08.10 08.10 - 08.40 08.40 - 09.10 09.10 - 09.40 09.40 - 10.10 10.10 - 10.30 10.30 - 12.00 Pre-Test Hemodynamic in Pediatric Shock Echocardiography in Pediatric Shock Managing Pediatric Shock with USCOM Coffee/Tea Break SKILL STATION Basic Echo Measurements* Basic Echo Measurements* USCOM 12.00 - 13.00 13.00 - 16.00 Lunch Basic Echo Measurements* Basic Echo Measurements* USCOM Rubiana Sukardi, dr, SpA (K) Piprim B Yanuarso, dr, SpA (K) Irene Juniar, dr, SpA Rubiana Sukardi, dr, SpA (K) Piprim B Yanuarso, dr, SpA (K) Irene Juniar, dr, SpA Antonius H. Pudjiadi, dr, SpA (K) Rubiana Sukardi, dr, SpA (K) Irene Juniar, dr, SpA PROGRAM Opening Speech INSTRUCTOR Antonius H. Pudjiadi, dr, SpA (K)

DAY 2 - TUESDAY, 18 OCTOBER 2011 TIME PROGRAM INSTRUCTOR Piprim B Yanuarso, dr, SpA (K) Novik Budhiwardana, dr, SpA Novik Budhiwardana, dr, SpA 08.00 - 08.20 Colloids and Crystalloids 08.20 - 08.40 Inotropics, Vasopressors and Vasodilators 08.40 - 09.00 Managing Critical Tachyarrthymias 09.00 - 09.20 Coffee/Tea Break 09.20 - 12.00 SKILL STATIONS Tachyarrythnia and Defibrilation Algorithm, Fluid, Drugs, using USCOM Algorithm, Fluid, Drugs, using Echo Algorithm, Fluid, Drugs, using Echo 12.00 - 13.00 Lunch 13.00 - 15.00 Panel 15.00 - 15.20 Coffee/Tea Break 15.20 - 15.50 Post-Test 15.50 - 16.00 Closing Speech All Instructors Novik Budhiwardana, dr, SpA Irene Juniar, dr, SpA Piprim B Yanuarso, dr, SpA (K) Rubiana Sukardi, dr, SpA (K)

PERIOPERATIVE MANAGEMENT IN NICU (For Physicians Only)

MONDAY, 17 OCTOBER 2011 DISCOVERY ROOM , Discovery Kartika Plaza, Kuta BALI Workshop Director: Risma K. Kaban, dr, SpA

TIME

PROGRAM

INSTRUCTOR Risma K. Kaban, dr, SpA (K)

08.00-09.00 Indications, complication and procedure of Peripherally Inserted Central Venous Catheter (PICC) 09.00-10.00 High Frequency Oscillatory Ventilation in Neonate with Respiratory Problem 10.00-10.15 Coffee/Tea Break 10.15-11.15 Neonatal Emergency Transport to Referral Hospital for Surgery and Sick Patient 11.15-12.15 Preparing Total Parenteral Nutrition in post Operative Patient 12.15-13.00 Lunch SKILL STATIONS 13.00-13.45 PICC in Neonate 13.45-14.30 HFOV in Neonate with Respiratory Problem 14.30-15.15 Neonatal Emergency Transport to Referral Hospital 15.15-16.00 Preparing Total Parenteral Nutrition in Post Operative Patient

Howard W. Needelman, MD (USA)

Philip Henschke, MD (Australia)

Rinawati Rohsiswatmo, dr, SpA (K)

Risma K. Kaban, dr, SpA (K) Howard W. Needelman, MD (USA) Lily Rundjan, dr, SpA (K) Philip Henschke, MD (Australia) Rosalina D. Roeslani, dr, SpA Rinawati Rohsiswatmo, dr, SpA (K) Ms. Rina

Scientific Program 4rh Indonesian Picu Nicu Update

SATURDAY - SUNDAY, 15-16 OCTOBER 2011
KHARISMA BALLROOM, DISCOVERY KARTIKA PLAZA, KUTA BALI

DAY 1
08.00-08.30

SATURDAY, 15 OCTOBER 2011

Grand Opening KEYNOTE LECTURE Chairperson: Antonius Pudjiadi, dr, SpA (K) (Jakarta)

08.30 - 09.00 09.00 - 09.30 09.30 - 09.40 09.40 - 10.10

10.10 - 10.30 10.30 - 10.50 10.50 - 11.10 11.10 - 11.25 11.25 - 11.45 11.45 - 12.05 12.05 - 12.15 12.15 - 13.15

Death and Dying in Neonates and Children How Important is Glucose Control in Critically ill Children? Discussion Coffee Break SPECIAL LECTURE Chairperson: Enny Harliany Alwy, dr, SpA (K) (Bandung) Intravenous Immunoglobuline : Is Past Or Present? The Role of Vasopressor in Pediatric Septic Shock The Use of Inodilator in Children with Shock Discussion ROTAVIRUS UPDATE

Albert P. Bos, MD (Netherlands) Vincent G.M Geukers, MD (Netherlands)

Antonius Pudjiadi, dr, SpA (K) (Jakarta) Piprim B. Yanuarso, dr, SpA (K) (Jakarta) Novik Budiwardhana, dr, SpA (Jakarta)

13.15 - 13.30 13.30 - 13.45 13.45 - 14.00 14.00 - 14.10

14.10 - 14.30 14.30 - 14.50 14.50 - 15.10 15.10 - 15.20

15.20 - 15.50 15.50 - 16.20 16.20 - 16.50 16.50 - 17.20 17.20 - 17.30

RVGE in Children: The Global & Indonesian Perspectives The Challenge in RVGE Prevention in Children Discussion Lunch YOUNG INVESTIGATOR FORUM Chairperson: Rismala Dewi, dr, SpA (K) (Jakarta) Validation of Non Verbal Pain Scale on Pediatric Intensive Care Unit Adrenal Insufficiency in Pediatric Sepsis Factors Associated of Extubation Failure in Post Operative Cardiac Surgery Children Discussion RESPIRATORY & HEMODYNAMIC UPDATE Chairperson: Ida Bagus Gede Suparyatha, dr, SpA (Bali) A Large Step Toward Improved Lung Protection Prediction of Fluid Reponsiveness in Children Brain Natriuretic Peptide as a Preload Predictor in Chronic Hypoxemia Discussion KEYNOTE LECTURE Chairperson: Prof. Munar Lubis, dr, SpA (K) (Medan) Integrated Patient Management System Understanding Hypoxia: From Basic to Bedside High Protein Intake for Perioperative Pediatric Patient Cardiac Function in Septic Shock Survivors Discussion

TBA TBA

Dyah Kanya Wati, dr, SpA (Bali) Irma Rachmawati, dr, SpA (Jakarta) Jose Meky Mandei, dr, SpA (Manado)

Ririe Fachrina Malisie, dr, SpA (K) (Riau) Johny Nurman, dr, SpA (Jakarta) Rubiana Sukardi, dr, SpA (K) (Jakarta)

Richard Topping (United Kingdom) Abdul Latief, dr, SpA (K) (Jakarta) Vincent G.M Geukers, MD (Netherlands) Albert P. Bos, MD (Netherlands)

Scientific Program 4rh Indonesian Picu Nicu Update

SATURDAY - SUNDAY, 15-16 OCTOBER 2011
KHARISMA BALLROOM, DISCOVERY KARTIKA PLAZA, KUTA BALI

DAY 2

SUNDAY, 16 OCTOBER 2011

KEYNOTE LECTURE Chairperson: Lily Rundjan, dr, SpA (K) (Jakarta) 08.00-08.30 High Frequency Oscillatory Ventilation in Neonate Howard W. Needelman, MD (USA) with Respiratory Problem 08.30-09.00 Indications and Complications of Peripherally Risma Kerina Kaban, dr, SpA (K) (Jakarta) Inserted Central Venous Catheter (PICC) in High Risk Baby 09.00-09.30 Neonatal Emergency Transport to the Referral Philip Henschke, MD, MBBS (Australia) Hospital for Surgery and Sick Patient 09.30-09.45 Discussion 09.45 - 10.15 Coffee Break PERI & POST OPERATIVE MANAGEMENT IN NICU Chairperson: Risma Kerina Kaban, dr, SpA (K) (Jakarta) 10.15 - 10.45 Gastro Intestinal Disorders in NICU: Howard W. Needelman, MD (USA) Nutrition Management Pre and Post Operation 10.45 - 11.15 Hernia Diaphragmatica in NICU: Respiratory Management Pre and Post Operation with HVOF and Nitric Oxide 11.15 - 11.45 Cardiac Disease in NICU: How Important Echo Cardiography and Nitric Oxide to Manage Cardiac Surgery Patient 11.45 - 12.00 Discussion 12.00 - 13.00 Lunch CENTRAL NERVOUS SYSTEM UPDATE Chairperson: Rinawati Rohsiswatmo, dr, SpA (K) (Jakarta) 13.00 - 13.20 Long Term Neuro Developmental Outcome of Premature Infant 13.20 - 13.40 Ultrasound Imaging in NICU 13.40 - 14.00 Therapeutic Hypothermia in Hypoxic Ischaemic Encephalopathy Babies 14.00 - 14.15 Discussion PEDIATRIC EMERGENCY UPDATE Chairperson: Setiabudhy, dr, SpA (K) (Malang) 14.15 - 14.35 Early Goal Directed Therapy in Sepsis Treatment 14.35 - 14.55 Pediatric Resuscitation and Life Support: ABC or CAB ? 14.55 - 15.15 Pediatric Critically ill Patient Transport 15.15 - 15.30 Discussion 15.30 - 15.45 Closing Remark Philip Henschke, MD, MBBS (Australia)

Howard W. Needelman, MD (USA)

Hardiono D. Pusponegoro, dr, SpA (K) (Jakarta) Evita Bermanshah Ifran, dr, SpA (K) (Jakarta) Lily Rundjan, dr, SpA (K) (Jakarta)

DR. Dr. Dadang Hudaya Somasetia, SpA K (Bandung) Dzulfikar Djalil, dr, SpA (K) (Bandung) M.Supriyatna TS, dr, SpA (Semarang)

Registration & Accomodation: Information

*Please note that all bank charges must be borne by the applicant* The payment should be made under participants name. Please Indicate Participants complete address and/or Sponsors Contact Number.

HOW TO REGISTER?
REGISTRATION VIA FAX
Recommended for domestic participants only. 1. Complete and fax the Registration Form to the secretariat fax address at +62.21.3153392 along with proof of payment [e.g. copy of bank transfer slip]. Photocopied forms are acceptable. Payment Proof is strongly recommended to be done along with your Registration Form faxed submission. 2. The Registration Form will not be acknowledged until the appropriate Payment Proof has been received to the Secretariat by fax to 021-3153392 as soon as possible following the Registration Form submission in max 2 working days. 3. Registration will not be acknowledged until the appropriate payment have been cashed and effectively in the event bank account. 4. Special Notification: Pharmaceutical group registrations may contact the Secretariat address for specific procedure.

REGISTRATION PAYMENT METHOD

A. BANK TRANFER => Bank transfer is strongly recommended rather than any other payment method. => Bank remittance must be paid by registrant, otherwise the registration receipt or badge will not be issued due to the less payment.
EVENT BANK ACCOUNT

Bank Name : CIMB Niaga Branch : Kemang Branch Address : Jalan Kemang Raya No. 4, Jakarta Selatan

No. Account : 253-01-00004.002 SWIFT CODE : BNIAIDJA Account Holder : GEO convex

B. CASH TO SECRETARIAT ADDRESS => Cash may be paid directly to the Secretariat Address(s). Rooms and Workshops payments must be full paid in advanced due to secure the space. C. ON SITE PAYMENT => On site payment [valid for Registration only, NOT for Rooms nor Workshops] with Bank Notes IDR, or Bank Drafts, shall be brought upon arrival and to be drawn on Indonesia Bank. The Bank Draft is to be made payable to GEO convex. Please indicate your On Site Payment remark on the registration form. Please acknowledge that Organizing Committee reserve the right not to guarantee any on-site registrant obtain its complete Symposium documents nor materials that therefore we strongly encourage to make an urge Registration. => Payment by Credit Card with EDC Machine will only be provided at the venue hotel by signing yourself authorization and the Credit Card transaction charges will be applied based on venue hotels regulation. The Organizing Committee holds no responsibility for any exchange rates applied by the Credit Card vendor when the statement converted into local currency.

REGISTRATION CONFIRMATION
Registration re-confirmation especially for Course/Workshop and/or Room Reservation are A Must due the availability of space. Organizing Committee reserve the right not to guarantee any unconfirmed Course/Workshop registration at the Event and the payment made will be returned by bank transfer only to the Payer Bank Account after the event. a. Registered Participants are strongly suggested to make reconfirmation due to incoming facsimiles and/or payments made to our Registration Division. Fax To: 021.3153392 >> Reconfirm To: 021.32244117 118, 021.3149318 - 19 and 021.2305835 Mobile: 0811.88.2080 b. Registered participants will receive Registration Official Receipt (upon request) after the fees have been cashed and effectively in the Event bank account. c. Participants are requested to bring the mentioned receipt Official Receipt copy of payment proof to facilitate Re-Registration procedures as foreseen at Registration Counters during event. Photocopied are acceptable. In fact, Name Badge will be issued as an initial confirmation of your receipt.

Registration Fee Include

Name Badge & Symposium Kit. Name Badge MUST BE worn entering to all scientific sessions and lunch/break programmed by the Organizing Committee. Symposium documents and materials (Proceeding Book and Note Pad) Admission to the function room, lunch programmed and Pharmaceutical and Health-Care Companies. Certificate of Attendance with IDI Accreditation & SKP IDI will be issued for eligible participants at the last day of the Symposium.

scientific exposure from

Due to P2KB of Indonesian Pediatric Society requirement, 70% attendance is strictly required for Pediatricians that the electronic absences will be applied during event held

RE-REGISTRATION SERVICE
The Re-Registration will be handed out to the participants from registration counters during the opening hours at 07.00 15.00 during the Scientific Meeting dates.

ON SITE REGISTRATION
Applicants that not registered in event Registration List will be treated as New Registrants and will have to register on-site, for which only payment by Cash or Credit Card are accepted.

CANCELLATION AND REFUND POLICY

REGISTRATION Notification of Registration cancellation for scientific symposium must be made in writing or emailed to the Secretariat. Registration Fee are refundable with the following cancellation policy: One month before event - 50% refund of Fee paid On and After the date - No refund No Show registration can not be refunded. ACCOMMODATION Hotel room rate is net for room only. Please note that official check-in time is 14.00 local time and check-out time is 12.00 local time. Approval of early check-in and late check-out is at discretion of the hotel. No reservation will be made without full deposit of nights booking due to room availability. Any changes and cancellations regarding to room reservation in pre-registration period must be done in writing to the Secretariat at least 336 hours prior to arrival. After the date, guaranteed payment for 1 night will be charged. No Show will be applied on the first night for delayed or postpone staying that causes the loss of 1 night room deposit made. In the event of materialization, the hotel will charge the full amount duration of stay upon check-out that causes the loss of mentioned deposit made.

Refund may only be made after the event by bank transfer. Official letter should be submitted to Secretariat address mentioning its payers Bank Account

Discovery Kartika Plaza, Kuta - Bali 15 16, 17 18 October 2011

REGISTRATION & ACCOMMODATION FORM

PARTICIPANT (Kindly completed)

Full Name & Title Institution Home Address City / Post Code Phone (Mobile) Email : : : : : : Fax:

SPONSOR (Kindly completed if any)

Full Name & Position : Company / City Phone (Mobile) Email : : : Fax:

REGISTRATION FEE (kindly ( ) appropriate box)

SYMPOSIUM REGISTRATION 15 - 16 OCTOBER 2011 PHYSICIANS NON PHYSICIANS/TRAINEE POST-SYMPOSIUM WORKSHOPS VENTILATORY SUPPORT PRACTICE FOR CLINICAL APPLICATIONS IN PICU NICU (For Physicians Only) MANAGEMENT OF PEDIATRIC SHOCK IN PICU (For Physicians Only) PERIOPERATIVE MANAGEMENT IN NICU (For Physicians Only) BEFORE 01 AUgUST 2011 IDR 2.500.000,IDR 2.000.000,DATE 17 - 18 OCTOBER 2011 17 - 18 OCTOBER 2011 17 OCTOBER 2011 AFTER 01 AUgUST 2011 IDR 3.000.000,IDR 2.500.000,WORKSHOP FEE IDR 3.000.000,IDR 3.000.000,IDR 3.000.000,-

HOTEL RESERVATION
Due to the limited number of rooms at venue hotel, Please reconfirm the hotel rooms availability before made the hotel reservations. ACCOMODATION RATE IN NET/ROOM/NITE SINglE BASIS, INClUDE BBF Discovery Kartika Plaza, Kuta - Bali (FULL) ROOM TYPE Deluxe Garden Room Ocean Facing Room Private Garden Room Bali Rani / The Rani, Kuta - Bali Adhi Jaya, Kuta - Bali Check In Date: Total Night(s): Total Accommodation Payment: IDR Deluxe Room Deluxe Room Check Out Date: ROOM RATE IDR 1.500.000,IDR 1.600.000,IDR 1.800.000,IDR 970.000,IDR 900.000,-

PAYMENT BY (Kindly () appropriate box

BANK TRANSFER IN FULL AMOUNT TO:
EVENT BANK ACCOUNT Bank Name : CIMB Niaga SWIFT CODE : BNIAIDJA Address : Jalan Kemang Raya No. 4, Jakarta Selatan No. Account : 253-01-00004.002 Branch : Kemang Branch Account Holder : GEO convex

CASH TO SECRETARIAT ADDRESS

Secretariat

INDONESIAN PEDIATRIC SOCIETY (IKATAN DOKTER ANAK INDONESIA) PEDIATRIC CRITICAL CARE WORKING GROUP Gedung IDAI, Departement IKA FKUI RSCM Jl. Salemba No 6 Jakarta Pusat 10430 Phone : 021-3148610 / 3100674

C/O. Global Echo Organizer convex Jl. Kebon Sirih Timur No. 4 Jakarta Pusat 10340 - Indonesia Tel : +62 21-3149318 / 3149319 Mobile : +62812.8586775 , Fax : +62 21-3153392 Homepage: www.geoconvex.com Email : secretariat@geoconvex.com