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Dear Colleagues,
3 SECRETARIAT analgesia, but also we should think beyond it, the impact
of anesthesia on their future life. So in this meeting
ACCOMMODATION
INFORMATION Heru Dwi Jatmiko, MD
CHA IR M A N OF 9 T H ISPA CC 2 0 1 7 SEM A R A NG
7 REGISTRATION
FORM
ACCOMMODATION 8
FORM
STEERING COMMITTEE
President of Indonesian Society of Anesthesiology and Intensive Care (PERDATIN)
Indonesian Symposium of Pediatric Anesthesia and Critical Care
President of Indonesian Pediatric Anesthesia Association
Jl. Dr. Soetomo No. 16, Semarang 50143
Chairman of Perdatin, Central Java
Phone / Fax : +6224 8444346
Organizing Committee Email : ispacc.semarang@gmail.com
Chairman : dr. Heru Dwi Jatmiko, SpAn, KAKV, KAP
Secretary : dr. Bondan Irtani Cahyadi, SpAn
Treasurer : dr. Widya Istanto Nurcahyo, SpAn, KAKV, KAR
Scienti c Committee:
Dr. dr. M. Sofyan Harahap, SpAn, KNA
Co-Organizer by
Dr. dr. Arie Untariani, SpAn, KAP
GPD Indonesia
Dr. dr. Jayanti Mandasari, SpAn, KAP
Jl. Kebalen V No. 24A Kebayoran Baru, Jakarta 12180
dr. Andi Ade Wijaya, SpAn, KAP
Phone: +62 21 7254424 / 7229339
dr. Himawan Sasongko, SpAn, KNA
Fax: +62 21 7396261
dr. Eri Leksana, SpAn, KIC, KAO
Mobile : +62 8111 332664, +62 8111 662664
r r n
Contact : Erlin
Email : erlin@gpdindonesia.com / gpd@gpdindonesia.com
Workshop Committee:
dr. Doso Sutiyono, SpAn, MARS
r n ri n n
dr. Jati Listiyanto Pudjo, SpAn, KIC
Funds Committee:
dr. Danu Soesilowati, SpAn, KIC
dr. Hari Hendriarto Satoto, MSi. Med, SpAn, KAKV
Beverages
Food & Beverages:
dr. Yulia Wahyu Villyastuti, SpAn
Documentation
Publication & Documentation:
dr. Tatag Istanto, SpAn
Security
Security:
dr. Satrio Adi Wicaksono, SpAn
04 INDONESIAN SYMPOSIUM OF PEDIATRIC ANESTHESIA AND CRITICAL CARE (ISPACC) INDONESIAN SYMPOSIUM OF PEDIATRIC ANESTHESIA AND CRITICAL CARE (ISPACC)
05
REGISTRATION FORM
Indonesian Symposium
REGISTRATION AND of Pediatric Anesthesia
And Critical Care
ACCOMMODATION
(ISPACC)
SECRETARIAT 1 Pediatric Emergency and Critical Care Ultrasound (WINFOCUS) March 22nd - 23rd Rp. 4,000,000 Rp. 4,500,000
ill e e e rin n i e re i r i n N re n ill 2 TOT Safe Pediatric Anesthesia March 22nd - 23rd Rp. 2,500,000 Rp. 3,000,000
e e r n i e re i r i n ee 3 Noenatal Resuscitation Training (Perinasia) March 22nd - 23rd Rp. 2,500,000 Rp. 3,000,000
In onesian Socie of Anesthesiologist an Intensive Care 4 Pediatric Fundamental Critical Care Support (PFCCS) March 22nd - 23rd Rp. 2,500,000 Rp. 3,000,000
5 Pediatric Mechanical Ventilation Manajemen March 22nd - 23rd Rp. 2,500,000 Rp. 3,000,000
REGISTRATION PAYMENT Dr Soetomo 16, Semarang 50143 6 Pediatric Regional Anesthesia March 22nd - 23rd Rp. 2,500,000 Rp. 3,000,000
Phone : +62 24 8444346 7 Pediatric Perioperative of Anesthesia and Critical Care March 22nd - 23rd Rp. 2,500,000 Rp. 3,000,000
All re i r i n ee e i n r n er
8 Pediatric Sedation And Pain March 22nd - 23rd Rp. 2,500,000 Rp. 3,000,000
Re i r n l e r ll n r e Ple e en Fax : +62 24 8444346 9 Airway Management (CPD) March 22nd - 23rd Rp. 2,500,000 Rp. 3,000,000
e r n i n l n i e re i r i n e E il :i e r n il m REGISTRATION FEE
NO PARTICIPANT
Organizing C i ee < 1 February 2017 > 1 February 2017
PT GPD In ne i 1 Specialist Rp. 2,750,000 Rp. 3,000,000
HOTEL POLICY e len N A r 2 General Practitioner / Resident Rp. 1,750,000 Rp. 2,000,000
3 Nurse Rp. 1,250,000 Rp. 1,500,000
D e i e n n e el r e Phone : (+62 21) 7229339, 7254424
i e n re e n re e re ri r n l Fax : (+62 21) 7396261
re en e e rl re er i n ile : +62 8111 332664, +62 8111 662664 CANCELLATION AND REFUND
Contact : Erlin Cancellation should be submitted by letter before March 1st, 2017. 50% refund will be transfer
after the implementation of the program is done. No refund will be allowed thereafter.
E il : erlin g in onesia com / g g in onesia com
BANK TRANSFER SIGNATURE
PAYMENT BY Bank Name : Bank Mandiri Branch RS Kariadi Semarang
n n iri r n RS ri i Semarang Acc. No : 135 001 473 1259
Acc No : 135 001 473 1259 Acc. Name : PANITIA ISPACC 2017
Acc Name : PANITIA ISPACC 2017 Swift Code : BMRIIDJA
Swift C e : BMRIIDJA
T
The Congress Secretariat at GPD Indonesia Jl. Kebalen V No. 24A Kebayoran Baru, Jakarta Selatan 12180
Phone: +6221 725 4424, +6221 722 9339 | Mobile: +628111332664, +628111662664 | Fax: +6221 7396261
Email: erlin@gpdindonesia.com, ispacc.semarang@gmail.com
Indonesian Symposium
of Pediatric Anesthesia
And Critical Care
(ISPACC)
PARTICIPANT DATA (Please Complete)
Title : PROF DR 'Ubb Specialist Others ________
Full Name : ___________________________________________________________
Institution : ___________________________________________________________
Address : ___________________________________________________________
___________________________________________________________
ZIP Code : ___________________________________________________________
Phone Number : ___________________________________________________________
E-mail Address : ___________________________________________________________
Sponsor : ___________________________________________________________
Person In Charge : Mr. Ms. _____________________________________________
Phone Number : ___________________________________________________________
REGISTRATION FEE
Please mark 5 on the Hotel you choose.
HOTEL ROOM TYPE RATE
BANK TRANSFER
Bank Name : Bank Mandiri Branch RS Kariadi Semarang SIGNATURE
Acc. No : 135 001 473 1259
Acc. Name : PANITIA ISPACC 2017
Swift Code : BMRIIDJA
T+6)25072*(7+(5:7+7+(5(4867(3$<0(17$1'b25'2&80(17$7216+28/'%(b(0$/(')$;('72
The Congress Secretariat at GPD Indonesia Jl. Kebalen V No. 24A Kebayoran Baru, Jakarta Selatan 12180
Phone: +6221 725 4424, +6221 722 9339 | Mobile: +628111332664, +628111662664 | Fax: +6221 7396261
Email: erlin@gpdindonesia.com
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