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Cabang Sumatera Utara

INDONESIAN PEDIATRIC SOCIETY (IKATAN DOKTER ANAK INDONESIA) PEDIATRIC CRITICAL CARE WORKING GROUP Proudly present and organized

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INDONESIAN

PRE SYMPOSIUM WORKSHOPS Thursday - Friday, 16 – 17 May 2013 • VENTILATORY SUPPORT PRACTICE FOR CLINICAL APPLICATIONS IN PICU-NICU (For Physicians Only) • MANAGEMENT OF PEDIATRIC SHOCK IN PICU (For Physicians Only) • FLUID, ELECTROLYTE AND ACID BASE MANAGEMENT (For Physicians Only)

U . P . D . A . T . E

JW Marriott Medan 16-17, 18-19 May 2013

Friday, 17 May 2013 • WORKSHOP IN IMPROVING QUALITY LIFE IN NEONATAL INTENSIVE CARE* (For Physicians Only) * To be advised

4th Indonesian PICU NICU Update & Exhibition Thursday - Friday, 16 – 17 May 2013

Cabang Sumatera Utara

Indonesian Pediatric Society (IDAI) Pediatric Critical Care Working Group Gedung IDAI, Jalan Dempo No.13, Matraman Dalam Jakarta Pusat Tel: 021.3148610 Fax: 021.3913982 For Registration and Accomodation Booking, please contact secretariat : C/O. Global Echo Organizer convex Jl. Kebon Sirih Timur No. 4, Central Jakarta – 10340, Indonesia Tel: (62-21)3149318 – 19 Fax: (62-21) 3153392 Communication Hotline: +628128586775 Registration On-Line: http://www.geoconvex.com/registration

FIRST ANNOUNCEMENT


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WELCOME MESSAGE

Dear Colleagues, Encouraging the development of the clinical treatment updates and appropriate application of new and existing critical care technologies and treatments to infants, children, and adolescents with life threatening illness, the Pediatric Critical Care Working Group is holding its annual 5th Indonesian PICU-NICU Update in a completely new mood to the east education center of Medan. The 5th Indonesian PICU-NICU Update will be held from 18 - 19 May 2013 and will be packed with some favorite PICU and NICU Workshops on 16 – 17 May 2013. The organizing committee has decided that we should examine some of the issues that we face on a daily practice, an exciting and challenging scientific program has been created and collaborated between pediatric and neonatal critical care professionals. Involving our outstanding international and national speakers in the field of Pediatric and Neonates Critical Care, who saw the opportunity to combine expertise, we share the experience and influence to improve the outcomes of infants and children suffering from life threatening illness and injury. We invite you to join us in harmony of multi-cultural blend to experiencing thriving metropolis city of Medan and its chilly culinary, and surely an ambitious scientific meeting with all cutting edge science from world leaders in pediatric and neonate critical care. Best wishes, Chairman The 5th Indonesian PICU NICU Update

Abdul Latief, dr, SpA K

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ORGANIZING COMMITTEE

Steering : Prof. Dr. Guslihan Dasa Tjipta, dr, SpA (K) – Ketua IDAI Cabang Sumatera Utara Prof. Dr. Munar Lubis, SpA (K) – Ka. Dept. Ilmu Kesehatan Anak FK USU – RSU H. Adam Malik Dadang Hudaya, dr, SpA (K) – Ketua UKK PGD/IDAI

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Chairman

: Abdul Latief, dr, SpA (K)

Secretary Scientific Committee

: ………………, dr, SpA (K) : 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 Dzulfikar Djalil, SpA (K)


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GENERAL INFORMATION

Event The 5th INDONESIAN PICU-NICU UPDATE

Place JW MARRIOTT MEDAN

Organized By Indonesian Pediatric Society – Pediatric Critical Care Working Group (UKK-PGD)

Audience Specialists in the field of NICU · Pediatric ICU; Respiralogy; Hematology; Infectious Diseases; Neurology; Nutrition & Metabolism; Gastroenterology; Immunology; Cardiology · Perinatology · Pediatric Surgery · Pediatric Anesthesiologists · Trainee · Intensivists · Emergency Doctors · General Practitioners

Agenda PRE SYMPOSIUM WORKSHOPS: Thursday - Friday, 16 – 17 May 2013 • Ventilatory Support Practice For Clinical Applications in PICU-NICU (For Physicians Only) • Management of Pediatric Shock in PICU (For Physicians Only) • Fluid , Electrolyte and Acid Base Management (For Physicians Only) Friday, 17 May 2013 * To be advised • Workshop in Improving Quality Life in Neonatal Intensive Care* (For Physicians Only) THE 5TH INDONESIAN PICU NICU UPDATE & EXHIBITION Saturday – Sunday, 18 – 19 May 2013

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 the 5th 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 Registration : secrétariat@geoconvex.com Homepage : www.geoconvex.com

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Registration & Accommodation: Office Hours: 021.3149318 – 3149319 Registration Hotline: 0811.882080 Fax: 021.3153392

Exhibition The 5th Indonesian PICU NICU Update will host a scientific exhibition on 18 – 19 May 2013 including the latest technology, equipment for clinical management & research and literature.

Pre Symposium Workshops To emphasize the importance of this essential part of its 5th 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 pre-symposium workshop programs. The program will be held on Thursday - Friday, 16 – 17 May 2013. See detail schedule.

Official Language The official languages of the 5th 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.

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PRE SYMPOSIUM WORKSHOPS Pre Symposium Workshop Certificate with IDI Accreditation & SKP IDAI will be issued for all workshop participants. We strongly suggest that Pre Symposium Workshop participants should be registered as a participant in terms of its scientific activities. Each workshop participant is limited to 75. Pre 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 upon payment made. In the case that payment made after full seats, the reimbursement will be made to its payer bank account.

AGENDA Thursday - 16 May 2013 Friday - 17 May 2013

Saturday - 18 May 2013

Sunday - 19 May 2013

PRE-SYMPOSIUM WORKSHOPS Management of Pediatric Shock in PICU-NICU (For Physicians Only) Ventilatory Support Practice For Clinical Applications In (For Physicians Only) Fluid, Electrolyte and Acid Base Management (For Physicians Only)

The 5th Indonesian PICU NICU Update & Exhibition

Workshop in Improving Quality Life in Neonatal Intensive Care* (For Physicians Only)

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VENTILATORY SUPPORT PRACTICE FOR CLINICAL APPLICATIONS IN PICU-NICU (For Physicians Only) THURSDAY – FRIDAY, 16 – 17 MAY 2013 Workshop Director: Abdul Latief, dr, SpA K

DAY 1 - THURSDAY, 16 MAY 2013 TIME 08.00-08.10

PROGRAM

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

11.00-11.30

Monitoring of Patient on Mechanical Ventilation

11.30-12.00

Weaning Mode

12.00-13.00

Lunch

Introduction

SKILL STATIONS 13.00 - 13.45

A. Ventilator Graphics

13.45 - 14.30

B. Initiating and Adjusting

14.30 - 15.15

C. Monitoring Patient on Mechanical Ventilation

15.15 - 15.30

Coffee/Tea Break

DAY 2 - FRIDAY, 17 MAY 2013 TIME

PROGRAM

08.00-08.30

Lung Protective Strategy

08.30-09.00

Lung Recruitment

09.00-09.20

Coffee/Tea break SKILL STATIONS

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

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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

15.00 - 15.15

Evaluation & Certification


MANAGEMENT OF PEDIATRIC SHOCK IN PICU (For Physicians Only) THURSDAY – FRIDAY, 16 – 17 MAY 2013 Workshop Director: Antonius H. Pudjiadi, dr, SpA K Workshop Co-Director: Rubiana Sukardi, dr, SpA

DAY 1 - THURSDAY, 16 MAY 2013 TIME

PROGRAM

08.00 - 08.10

Introduction

08.10 - 08.40

Pre-Test

08.40 - 09.10

Hemodynamic in Pediatric Shock

09.10 - 09.40

Echocardiography in Pediatric Shock

09.40 - 10.10

Managing Pediatric Shock with USCOM

10.10 - 10.30

Coffee/Tea Break

10.30 -

SKILL STATION Basic Echo Measurements USCOM

12.00 - 13.00 - 16.00

Lunch Basic Echo Measurements USCOM

DAY 2 - FRIDAY, 17 MAY 2013 TIME 08.00 - 08.20

PROGRAM 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 - 11.30

SKILL STATIONS Tachyarrythnia and Defibrilation Algorithm, Fluid, Drugs, using USCOM Algorithm, Fluid, Drugs, using Echo

11.30 - 13.00

Lunch

13.00 - 15.00

Panel Discussion

15.00 - 15.20

Coffee/Tea Break

15.20 – 15.30

Evaluation & Certification

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FLUID, ELECTROLYTE AND ACID BASE MANAGEMENT (For Physicians Only) THURSDAY – FRIDAY, 16 – 17 MAY 2013 Workshop Director: Ida Bagus Gede Suparyatha, dr, SpA K

TIME 08.00-08.10

PROGRAM

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

11.00-11.30

Monitoring of Patient on Mechanical Ventilation

11.30-12.00

Weaning Mode

12.00-13.00

Lunch

13.00 - 13.45

FOR

DAY 1 - THURSDAY, 16 MAY 2013

13.45 - 14.30

B. Initiating and Adjusting

14.30 - 15.15

C. Monitoring Patient on Mechanical Ventilation

15.15 - 15.30

Coffee/Tea Break

PO

SIT

ION

ON

LY

Introduction

SKILL STATIONS A. Ventilator Graphics

DAY 2 - FRIDAY, 17 MAY 2013 TIME

PROGRAM Lung Protective Strategy

08.30-09.00

Lung Recruitment

09.00-09.20

Coffee/Tea break

ON

LY

08.00-08.30

SKILL STATIONS

A. Bronchopneumonia & ARDS

10.05 - 10.50

B. Apnea of Prematurity

10.50 - 11.35

C. Meconeum Aspiration Syndrome

11.35 - 12.30

Lunch

PO S

ITI

ON

09.20 - 10.05

SKILL STATIONS 13.15 - 14.00 14.00 - 14.30

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D. Cardiopulmonary Interaction

FOR

12.30 - 13.15

E. Lung Recruitment Post-Test

14.30-15.00

Coffee/Tea Break

15.00 - 15.15

Evaluation & Certification


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SCIENTIFIC PROGRAM

The 5th INDONESIAN PICU NICU UPDATE

SATURDAY – SUNDAY, 18 – 19 MAY 2013 VENTILATOR SESSION • Stress, Strain and Lung Injury • Electrical Impedance: A New Tools in Managing Ventilation • Understanding and Management of Patient-Ventilator Desynchronize • What Do We Know About Weaning Failure? HEMODYNAMIC SESSION • How to Implement Early Goal Directed Therapy in Pediatric • Hemodynamic Monitoring in Children: What, When and How • Management of Shock in Children Using USCOM: The Indonesian Experience • How to Manage Pulmonary Edema in Children METABOLIC AND NUTRITION SESSION • IV Fluid Maintenance in PICU: Why, What, When and How? • Fluid Strategy in Neurological Diseases • Hypokalemia in Children: Cause, Consequence and Correction • Nutrition: Route, Rate, Type and Target SEPSIS AND ORGAN FAILURE • Combination of Antibiotics: Is It Beneficial for Sepsis? • Implementing Sepsis Management Bundle in Children • Clinical Application of Measuring Inflammatory Markers in The Management of Sepsis Children • Blood Lactate as an Early Resuscitation Target NEONATAL INTENSIVE CARE • Clinical Assessment of Extremely Premature Infants in the Delivery Room is a Poor Predictor of Survival • Cooling Newborns with Hypoxic Ischemic Encephalopathy • Reducing Lung Injury During Neonatal Resuscitation of Preterm Infants • Diagnosis Evaluation of Infants with Suspected Early Onset Sepsis • The Value of Lung Ultrasound in the Assessment and Management of Neonatal Respiratory Disorders • Eliminating Postnatal Growth Restriction with an Aggressive TPN and Feeding Protocol • Neonatal Intensive Care at Borderline Viability

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INTERNATIONAL INVITED SPEAKERS Peter Graham Davis, MD FRACP Professor Professor Peter Davis has been a consultant neonatologist at the Royal Women’s Hospital since 1993. He trained in Brisbane and McMaster University, Canada where he developed an interest in Clinical Epidemiology and Evidence Based Medicine. His clinical work is centered in the Neonatal Intensive Care Unit where he is the Director of the Neonatal Fellowship Program. He is heavily involved in undergraduate and post graduate education at the Royal Women’s Hospital. He has a keen interest in the dissemination of highest quality medical evidence to practitioners and consumers and is the Regional Coordinator of the Neonatal Review Group of the Cochrane Collaboration. He is the author of more than twenty Cochrane Reviews and is responsible for the recruitment and support of reviewers within Australasia.

His other research interests include alternative methods of respiratory support of premature babies, neonatal resuscitation and identification of important outcomes of neonatal intensive care. He has considerable experience in the design and conduct of international collaborative randomized controlled trials.

Lex William Doyle, MD BS MSc FRACP Professor

Professor Doyle has worked in the field of neonatal paediatrics for almost 30 years, and exclusively since 1978 when he was first appointed to the Department of Obstetrics and Gynaecology in the University of Melbourne. As well as training in Melbourne, he was fortunate to work and train for 3½ years in Canada, at McMaster University, where he met and worked with many esteemed international colleagues in neonatal paediatrics.

Professor Doyle has major research interests in evaluating neonatal intensive care, including how to improve on that care, and its economic consequences. He is a chief investigator on 6 randomised controlled trials of interventions designed to improve the outcome for the tiniest and most immature babies. He leads several research groups interested in the outcome for tiny babies well beyond the nursery and into adulthood; these are the Premature Infant Follow-up Programme at the Royal Women’s Hospital, and the Victorian Infant Collaborative Study Group. As a consequence of his research activities he has over 170 scientific publications, one book, and two completed theses (MSc [McMaster]; MD [Melbourne]) to date 2004.

In addition to his research activities, Professor Doyle maintains a full clinical workload in the care of newborn babies at the Royal Women’s Hospital, as is heavily involved in undergraduate and postgraduate medical and research education, mentoring, and supervision.

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REGISTRATION & ACCOMMODATION

HOW TO GET THE REGISTRATION FORM 1. From our website: • Download the PDF file of the updated “Announcement” by logged into http://www. geoconvex.com/upcoming-event/ and click further to mentioned related event. • Find the last pages of Announcement to print the Registration Form for fax purpose. You may also save the soft copy in your personal PC for your perusal. 2. From our secretariat address: You may get the soft/hard copy of Announcement to be delivered to your email/ home address by sending the request to secretariat@geoconvex.com or SMS to +62811882080

HOW TO REGISTER Registration By Fax 1. Complete the Registration Form to the secretariat Fax address at 021.3153392 along with proof of payment [e.g. copy of bank transfer slip]. Photocopied forms are acceptable. 2. Payment Proof is strongly recommended to be done along with your Registration Form faxed submission. 3. 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. 4. You may bring along your payment proof to proceed at the Re-Registration counter. Essentially, the name tag issued is an initial confirmation of registrants. Fax of an official receipt is upon request to Secretariat address at 021.3149318 – 3149319.

Registration Payment A. Bank Transfer Bank transfer is strongly recommended rather than any other payment method. See event bank account in the mentioned Announcement. 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 FOR The 5th INDONESIAN PICU NICU UPDATE 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.

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C. On Site Payment On site payment shall be brought upon arrival. The Bank Draft is to be made payable to “GEO convex”. Please indicate your “On Site Payment” remark on the registration form. On site payment is only valid for conference registration, not eligible for workshops and rooms. Please acknowledge that Organizing Committee reserve the right not to guarantee any onsite 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 hotel’s 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 1. Registered participants will receive Registration Official Receipt (upon request) after the fees have been cashed and effectively in the Event bank account. 2. Registered Participants are strongly suggested to make Re-Confirmation due to incoming facsimiles and/or payment made to our Registration Division. Domestic Participant: Fax To: 021.3153392 ; Reconfirm To: 021.32244117 – 118, 021.3149318 – 19 and 021.2305835 Mobile: 0811.88.2080 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. Notification: For group registration from pharmaceutical companies as payers may contact the Secretariat email address for specific procedure. Cancellation and Refund Policy REGISTRATION Notification of the registration cancellation for scientific symposium must be made in writing or emailed to the Secretariat. Registration Fee is 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.

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• • • •

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 168 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.

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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 scientific exposure from 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.

RE-REGISTRATION SERVICE The Re-Registration will be handed out to the participants from registration counters during the opening hours at 07.00 – 12.00 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 cancella- tion 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 payer’s Bank Account.

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REGISTRATION & ACCOMMODATION FORM

REGISTRATION & ACCOMMODATION FORM PARTICIPANT (Kindly completed) Full Name & Title

: ________________________________________________________________________

Institution

: ________________________________________________________________________

Home Address : ___________________________________________________________________________ City / Post Code : ___________________________________________________________________________ Phone (Mobile) : ___________________________________________ Fax : ___________________________ Email

: ___________________________________________________________________________

SPONSOR (Kindly completed if any) Full Name & Position

: ___________________________________________________________________

Company / City

: ________________________________________________________________________

Phone (Mobile)

: ___________________________________________ Fax : ________________________

Email

: _________________________________________________________________________

Pre -Symposium Workshops

Date

Workshop Fee

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

16 – 17 May 2013

IDR 3.000.000,-

MANAGEMENT OF PEDIATRIC SHOCK IN PICU (For Physicians Only)

16 – 17 May 2013

IDR 3.000.000,-

FLUID, ELECTROLYTE AND ACID BASE MANAGEMENT (For Physicians Only)

16 – 17 May 2013

IDR 3.000.000,-

17 May 2013

IDR 1.750.000,-

WORKSHOP IN IMPROVING QUALITY LIFE IN NEONATAL INTENSIVE CARE* (For Physicians Only)

REGISTRATION FEE ( kindly √ appropriate circle) Symposium Registration 18 – 19 May 2013

Before 01 April 2013

After 01 April 2013

Physicians

IDR 2.250.000,-

IDR 2.500.000,-

Non Physicians/Trainee

IDR 1.750.000,-

IDR 2.000.000,-


HOTEL RESERVATION Due to the limited number of rooms at venue hotel, Please reconfirm the hotel rooms availability before made the hotel reservations Hotel Name

ROOM TYPE

Room Rate Rate in Net/Room/Night– Single Basis, Include BBF

JW Marriott Medan

Deluxe Room

IDR 850.000,-

Check In Date: ____/____/________

Check Out Date: ____/____/_____

Total Night(s) :____________________ Total Accommodation Payment, IDR/USD :____________________

PAYMENT BY (Kindly √ appropriate circle) BANK TRANSFER IN FULL AMOUNT TO

CASH TO SECRETARIAT ADDRESS

EVENT BANK ACCOUNT (IDR/USD) Account Holder (Beneficiary) : GEO convex No. Account : 253-01-00167-00-4 Bank Name : CIMB Niaga Branch : Kemang Branch Address : Jalan Kemang Raya No. 4, Jakarta Selatan SWIFT CODE : BNIAIDJA*

*Remittance to Indonesian Banks only need you to put the SWIFT Code. IBAN/Routing is unnecessary


PICU NICU 2013-MEDAN  

1st Announcement

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