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PICNIC ACADEMIA

REGULAR COURSE 2017-2018

The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri Gawat Darurat Indonesia) is an independent non-profi t organization, plays an important role in this continuing learning journey by providing expertise and resources to complement existing pedagogy and strategic methodologies-blended-teaching and learning module in emergency and critical care fi elds. Through education and learning, The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri Gawat Darurat Indonesia) offers a wide spectrum of programmes covering pediatric and multidisciplinary topics in developing healthcare educations, creating the new-breed skilled manpower, and enhancing learning processes through a suite of its expertise and resources.

The Indonesian Pediatric Critical Care Foundation is the professional home of multi disciplines physicians and subspecialists as well as other child health providers, including general practitioners and nurses.

We provide continuing learning journey by expertise in tools, information and resources to help practitioners provide the highest quality health care and new-breed skilled manpower through existing pedagogy and strategic methodologies-blended-teaching and learning module in emergency and critical care fi elds.

SIGNUP AND REGISTER OUR FREE MEMBERSHIP TODAY WITH A DIRECT INVOLVEMENT IN OUR INNOVATION LEARNING JOURNEY AND UPDATES VIA http://www.picunicu.org/

THE FOUNDATIONThe Indonesian Pediatric Critical Care Foundation(Yayasan Pediatri Gawat Darurat Indonesia)

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PICNIC ACADEMIA

REGULAR COURSE 2017-2018

MANAGEMENT COMMITTEE

CO-CHAIR

Yani Akhyar KasimDarlan DarwisH. Munar Lubis

STRATEGIC TEAM

TRUSTEE

Susetyo Harry PurwantoDadang Hudaya Somasetia

Silvia Triratna

PRESIDENT

Abdul Latief

VICE-PRESIDENT

Antonius H. Pudjiadi

TREASURER

Eva Miranda Marwali

MEMBERS

Chairul YoelDzulfi kar Djalil Lukmanul Hakim

Novik Budi WardhanaRirie Fachrina Malisie

Irene YuniarRismala DewiNurnaningsih

Rinawati RohsiswatmoRisma Kerina Kaban

Lily RundjanRosalina Dewi Roeslani

Abdul LatiefAntonius H. PudjiadiRirie Fachrina Malisie

Rinawati RohsiswatmoLily Rundjan

To achieve learning excellence, The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri Gawat DaruratIndonesia) resources and expertises are set to make comprehensive range of educational needs

FOUNDER

Abdul LatiefAntonius H. Pudjiadi

Dadang Hudaya Somasetia Darlan Darwis

Dzulfi kar Djalil Lukmanul HakimH. Munar Lubis

Novik Budi WardhanaSilvia Triratna

Susetyo Harry Purwanto

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PICNIC ACADEMIA

REGULAR COURSE 2017-2018

VISION

Partnering and supporting the Pediatric Critical Care Working Group of Indonesian Pediatric Society, Hospitals, Associations, Healthcare Institutions, Corporations and Government Agencies, both at national and international level, The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri Gawat Darurat Indonesia) has a strong pursuit and networks that provides a vibrant and conductive environment to empower healthcare professionals with expertise and resources needed to advance clinical knowledge and expertise in the effort of providing high quality patient care at frontiers of medicine.

MISSION

The mission is accomplished by promoting the professional growth and development of its diverse membership, representing general health professionals in pediatric emergency medicine and critical care, child health research, pediatric medical educations and related disciplines.

PRO COMMUNITY

Pro Community is a forum platform of scientifi c publication reviews for medical professionals in multidisciplinary nature to exchange ideas and having brief communication in variety topics to enhance the outlook of recent development in the fi eld of critical care and emergency medicine. All students undergoing medical research and/or training are also welcomed. Get the privilege involvement in the forum for being our member through website.

PICNIC ACADEMIA

The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri Gawat Darurat Indonesia) is well poised to provide quality healthcare education and learning to nurture from physicians –primarily pediatricians and its subspecialties; professionals across the healthcare disciplines; doctors, nurses to allied healthcare professionals, with a holistic set of skills essential for professional development and growth through the benefi t of curriculum, teaching methodologies and learning effi ciencies, both on-line (webinars and mini courses) in E-Learnovation basis and off-line (Scientifi c Events and Regular Courses).

WHAT WE DO

JOIN OUR PROGRAM

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REGULAR COURSE 2017-2018

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REGULAR COURSE 2017-2018 The Regular Course is the entry-level healthcare educational programme developed by Strategic Team to creating the new-breed skilled manpower, and enhancing learning processes through a suite of its expertise and resources.

It is a reserve training program with the curriculum divided in individual topics, which contain the minimum requiredfoundational knowledge for given subjects with stimulating hands-on for skillful requirement.

Regular Course – Period 2017-2018 with new comer curriculums are set as an entry level to participate in the Symposium Workshops of 10th Indonesian PICU NICU Update 20-26 March 2018 at The Stones Hotel Legian Bali.

Participants, who joined the Regular Course Period 2017-2018 will be prioritized to participate theSymposium Workshops of 10th Indonesian PICU NICU Update 20 – 26 March 2018

AGENDA

SWISS-BELHOTEL MALEOSAN - MANADO

FRIDAY, 14 JULY 2017 SATURDAY, 15 JULY 2017

Basic Mechanical Ventilation in Critically ill Children - Day 1

Basic Mechanical Ventilation in Critically ill Children- Day 2

ARYADUTA HOTEL PALEMBANG

15 SEPTEMBER 2017SATURDAY, 16 SEPTEMBER 2017

SUNDAY, 17 SEPTEMBER 2017

Diffi cult Airway in Critically ill Children

Basic Mechanical Ventilation in Critically ill Children - Day 1

Basic Mechanical Ventilation inCritically ill Children - Day 2

GRAND SWISS-BELHOTEL, MEDAN

SATURDAY, 28 OCTOBER 2017 SUNDAY, 29 OCTOBER 2017

Basic Mechanical Ventilation in Critically ill Children - Day 1

Basic Mechanical Ventilation in Critically ill Children- Day 2

GRAND JATRA HOTEL, BALIKPAPAN

SATURDAY, 18 NOVEMBER 2017 SUNDAY, 19 NOVEMBER 2017

Basic Mechanical Ventilation in Critically ill Children - Day 1

Basic Mechanical Ventilation in Critically ill Children- Day 2

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REGULAR COURSE 2017-2018

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WISMA 76, SLIPI - JAKARTA

08 DECEMBER 2017SATURDAY, 09 DECEMBER 2017

SUNDAY, 10 DECEMBER 2017

Diffi cult Airway in Critically ill Children

Basic Mechanical Ventilation in Critically ill Children - Day 1

Basic Mechanical Ventilation inCritically ill Children - Day 2

SANTIKA PREMIERE HOTEL BINTARO, TANGERANG

FRIDAY, 23 FEBRUARY 2018 SATURDAY, 24 FEBRUARY 2018 SUNDAY, 25 FEBRUARY 2018

Diffi cult Airway in Critically ill Children

Basic Mechanical Ventilation in Critically ill Children - Day 1

Basic Mechanical Ventilation inCritically ill Children - Day 2

Post Resuscitation – StabilizationManagement- Day 1

Post Resuscitation – StabilizationManagement - Day 2

Comprehensive Pediatric SepsisManagement – Day 1

Comprehensive Pediatric SepsisManagement – Day 2

Basic Non-Invasive Ventilationin Newborn Infants

Basic Mechanical Ventilation in Newborn Infants

Basic Mechanical Ventilation inNewborn Infants: Clinical Practice

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BASIC MECHANICAL VENTILATION IN CRITICALLY ILL CHILDREN WORKSHOP

INTRODUCTION To learn the indications; physiology; respiratory mechanism; and principal of mechanical ventilation in critically ill pediatrics, learn

about initial parameters; how to choose initial settings & adjustment as well as monitoring and weaning of mechanical ventilator support in sick children

TERM & CONDITION Basic Mechanical Ventilation in Pediatric Workshop is a compulsory entry level to join Advanced Modes on Mechanical Ventilation

in Children Workshop, which held as the Symposium Workshop of 10th Indonesian PICU NICU Update.

DATE Two Days Program *See above detail Agenda

PLACE *See above detail Agenda

COURSE DIRECTOR Dr. Ririe F. Malisie, dr, SpA(K)

PROGRAM

DAY 1 TOPIC

Opening Remark

08.15-08.45 Pre-Test

08.45-09.45 Basic Principles of Mechanical Ventilation in Children

09.45-10.00 Coffee Break

10.00-11.00 Ventilator Modes and Wave-Forms

11.00-11.45 Initial Setting and Adjusting of Mechanical Ventilation

11.45-12.00 Discussion

12.00-13.00 Lunch and Pray Time

13.00-16.00 SKILL STATIONS (1 hour rotated)

O2 and CO2 ProblemsInterpretation of Wave-FormsInitial Setting and Adjusting

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INSTRUCTOR TEAM Abdul Latief (Jakarta) Antonius Pudjiadi (Jakarta) Ririe Fachrina Malisie (Medan) Sri Martuti (Solo) G. Dharma Mulyo (Jakarta) Yusrina Istanti (Semarang) Saptadi Yuliarto (Malang)

DAY 2 TOPIC

Non-Invasive Ventilation in Critically ill Children

08.45-09.30 Monitoring of Children on Ventilatory Support

09.30-10.15 Weaning Strategies

10.15-10.30 Coffee Break

10.30-12.30 HANDS ON CASES SIMULATION (60” Rotated)Hypoxic Respiratory Failure (Severe Pneumonia)Hypercapnic Respiratory Failure (Asthma)Patient with Guillian Barre Syndrome

12.30-13.30 Lunch and Pray Time

13.30-14.30 HANDS ON CASES SIMULATION (Continued )Hypoxic Respiratory Failure (Severe Pneumonia)Hypercapnic Respiratory Failure (Asthma)Patient with Guillian Barre Syndrome

14.30-15.00 Post-Test

15.00-15.40 Evaluation & Course Wrap

15.40-16.00 Coffee Break

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DIFFICULT AIRWAY IN CRITICALLY ILL CHILDREN

INTRODUCTIONThe Pediatric Airway Skills Course equips learners with the tools necessary to manage a diffi cult pediatric airway in critically illchildren. The course will review patient positioning, techniques for improved airway visualization, as well as review skills and tools that can make a difference in the challenging airway patient. Learners will be exposed to laryngoscopic intubation, laryngealmask airways, bougies, GlideScopes, transtracheal jet ventilation as well as Seldinger and McIntyre cricothyroidotomies.

During the hands-on phase, learners will receive direct instruction and practice using this equipment. The learners will then apply their new knowledge by being placed into a high-fi delity simulation experience where they will be challenged to use these newtechniques.

This workshop is for trainees and consultants who wish to refresh and update skills in managing children in critically ill with a diffi cult airway. The course aims to discuss the management of the anticipated and unanticipated paediatric diffi cult airway. Theformat of the day is one of short interactive lectures, videos and hands-on small group workshops. The workshops cover careand basic use of the fi bre-optic laryngoscope, modifi ed airway and LMA access techniques using guidewires and exchange catheters.

DATEOne Day Program *See above detail Agenda

PLACE *See above detail Agenda

COURSE DIRECTOR: Dr. dr. Ririe Fachrina Malisie, SpA(K)CO-COURSE DIRECTOR Dr. dr. Dzulfi kar DLH, SpA (K), Mkes MMRS

PROGRAM

TIME TOPIC FACILITATOR

08.00 - 08.30 Registration

08.30 - 09.00 Pre-Test Ririe F Malisie

09.00 - 09.45 Introduction of Diffi cult Airway Management in Critically ill Children Abdul Latief

09.45 - 10.30 Recognition of Stridor and Diffi cult Airway in Pediatric Dzulfi kar DLH

10.30 - 11.30 Techniques and Galleries of Tools in Pediatric Diffi cult Airways Andi Ade Wijaya

11.30 - 12.00 Algorithm of Pediatric Diffi cult Airway Ririe F Malisie

12.00 - 13.00 Lunch & Pray

Skill Station: DRY WORKSHOP

13.00-16.00 The Devices to Maintain Open Airway in Critically ill Children Ririe F Malisie

Basic Airway Management & the Use of Video Laryngoscope Andi Ade Wijaya

Emergency Airway Management and Needle Cricothyroidotomy Dzulfi kar DLH

16.00 - 16.30 Post-Test Ririe F Malisie

16.30 - 16.45 Evaluation & Wrap Abdul Latief

16.45 - 17.00 Coffee/Tea Break

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POST RESUSCITATION - STABILIZATION MANAGEMENTINTRODUCTION Post-resuscitation care is a critical component of advanced life support. Patient mortality remains high after return of

spontaneous circulation and initial stabilization. Include the post-resuscitation care are: optimize hemodynamic, respiratory, and neurologic support; identify and treat reversible causes of arrest; and monitor temperature and consider treatment for disturbances of temperature regulation and metabolism. When spontaneous circulation is restored after cardiopulmonary arrest in critically ill children, these are the goals of treatment: • Avoid cardiopulmonary arrest recurrance• Restore perfusion and oxygenation• Evaluate and monitor neurologic functions• Support dysfunctioning organs• Resolve the situation that promoted cardiopulmonary arrestMulti organ failure secondary to hypoxic ischemic insult requires partial or complete support of each organ function.Strategies to keep systemic perfusion and oxygenation adequate are the rule. Maintaining and protecting neurologic function is essential for a good outcome.

DATE Two Days Program on 24 – 25 February 2018

PLACE Hotel Santika Premiere Bintaro – Tangerang Selatan

COURSE DIRECTOR & CO: Dr. dr. Dzulfi kar DLH, SpA(K) M.Kes MMRS & Dr. dr. Ririe Fachrina Malisie, Sp.A(K)

PROGRAM

DAY 1 SATURDAY, 24 FEBRUARY 2018 FACILITATOR08.00-08.15 Opening Remarks Dzulfi kar DLH

08.15-08.45 Pre-Test Ririe F Malisie

08.45-09.15 Mechanical Ventilation: Initial Setting and Adjusting Saptadi Yuliarto

09.15-09.45 Sedation & Analgesia Dzulfi kar DLH

09.45-10.00 Coffee break10.00-10.30 Management of Increased Intracranial Pressure Rismala Dewi

10.30-11.00 Hypo and Hyperglycemia Yusrina Istanti

11.00-12.00 SKILL SESSION

Divided to4 GroupsRotate

@60min

Mechanical Ventilation: Initial Setting and Adjusting Saptadi Yuliarto

Sedation & Analgesia Dzulfi kar DLH

Management of Increased Intracranial Pressure Rismala Dewi

Hypo and Hyperglycemia Yusrina Istanti

12.00-13.00 ISHOMA

13.00-16.00 SKILL SESSION…continued

Divided to4 GroupsRotate

@60min

Mechanical Ventilation: Initial Setting and Adjusting Saptadi Yuliarto

Sedation & Analgesia Dzulfi kar DLH

Management of Increased Intracranial Pressure Rismala Dewi

Hypo and Hyperglycemia Yusrina Istanti

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DAY 2 SUNDAY, 25 FEBRUARY 2018 FACILITATOR

08.00-08.30 Hemodynamic Assessment & Management Irene Yuniar

08.30-09.00 Fluid and Electrolytes Management Dzulfi kar DLH

09.00-09.15 Coffee Break

09.15-09.45 Disseminated Intravascular Coagulation Saptadi Yuliarto

09.45-10.15 Management of Systemic Infection Rismala Dewi

10.15-12.15 SKILL SESSION

Divided to 4 Groups

Rotate@60min

Hemodynamic Assessment & Management Irene Yuniar

Fluid and Electrolytes Management Dzulfi kar DLH

Disseminated Intravascular Coagulation Saptadi Yuliarto

Management of Systemic Infection Rismala Dewi

12.15-13.00 ISHOMA

13.00-16.00 SKILL SESSION (continued)

Divided to 4 Groups

Rotate@45min

Hemodynamic Assessment & Management Irene Yuniar

Fluid and Electrolytes Management Dzulfi kar DLH

Disseminated Intravascular Coagulation Saptadi Yuliarto

Management of Systemic Infection Rismala Dewi

16.00-16.30 Post-Test Ririe F Malisie

16.30-16.45 Evaluation & Course Wrap Dzulfi kar DLH

16.45-17.00 Coffee Break

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REGULAR COURSE 2017-2018

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COMPREHENSIVE PEDIATRIC SEPSIS MANAGEMENT

INTRODUCTIONTo enhance the updated knowledge and practical guidelines in the comprehensive management of sepsis in children included the understanding sepsis pathophysiology in children, the International standard for pediatrics sepsis & Surviving Sepsis Campaign as well as the Early Goals Directed Therapy for pediatric sepsis implementations upon the latest guidelines.

DATETwo Days Program on 24 – 25 February 2018

PLACEHotel Santika Premiere Bintaro – Tangerang Selatan

COURSE DIRECTOR & CO: Abdul Latief, dr, SpA(K)

PROGRAM

DAY 1 SATURDAY, 24 FEBRUARY 2018 FACILITATOR08.00 - 08.15 Introduction

08.15 - 08.45 Pre-Test Abdul Latief (Jakarta)

08.45 - 09.30 Overview of Indonesian Pediatric Sepsis Consensus Abdul Latief (Jakarta)

09.30 - 10.15 Surviving Sepsis Campaign Dadang Hudaya (Bandung)

10.15 - 10.30 Discussion

10.30 - 11.10 Coffee breakGROUP DISCUSSION[Participants are divided into 4 Groups @ 50 minutes Rotation]

11.10 - 12.00 Hemodynamic Support Strategy Irene Yuniar (Jakarta)

12.00 - 13.00 Lunch

13.00 - 13.50 Fighting Infections Rahma Mulya Karyanti (Jakarta)

13.50 - 14.40 Protective Ventilation Strategy M Supriatna (Semarang)

14.40 - 15.30 Glucose Control Nurnaningsih (Jogjakarta)

15.30 - 16.10 Coffee Break

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DAY 2 SUNDAY, 25 FEBRUARY 2018 FACILITATORGROUP DISCUSSION[Participants are divided into 4 Groups @ 50 minutes Rotation]

08.00 - 08.50 Sedative and Analgesic Dadang Hudaya (Bandung)

08.50 - 09.40 Coagulation Problems M Supriatna (Semarang)

09.40 - 10.00 Coffee Break

10.00 - 10.50 Pediatric Logistic Organ Dysfunction Score Abdul Latief (Jakarta)

10.50 - 11.40 Nutritional Support Nurnaningsih (Jogjakarta)

11.40 - 13.00 Lunch

13.30 - 14.30 Post Test Abdul Latief (Jakarta)

14.30 - 15.00 Course Wrap & Evaluation Abdul Latief (Jakarta)

15.00 - 15.30 Coffee Break

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REGULAR COURSE 2017-2018

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BASIC NON-INVASIVE VENTILATION IN NEWBORN INFANTS

DATEOne Day Program on Friday, 23 February 2018

PLACEHotel Santika Premiere Bintaro – Tangerang Selatan

COURSE DIRECTOR Risma K. Kaban, dr, SpA(K) - (Jakarta)

PROGRAM

DAY 1 FRIDAY, 23 FEBRUARY 2018 INSTRUCTOR08.00 - 08.15 Opening08.15 - 08.35 Basic Principles of Non Invasive Ventilation Rinawati Rohsiswatmo

08.35 - 08.55 CPAP Rosalina Roeslani

08.55 - 09.15 High Flow and Low Flow Nasal Cannulae Rosalina Roeslani

09.15 - 09.30 Discussion

09.30 - 09.50 Coffee break09.50 - 10.20 SiPAP: Complete Mode Rinawati Rohsiswatmo

10.20 - 10.50 Nursing Care of Non Invasive Ventilation Ns. Dian Anggur

10.50 - 11.20 Nasal IMV Adhi TP

11.20 - 11.50 Nasal HFO : New Modality Putri Maharani

13.20 - 15.35 SKILL STATION

Divided in to 3 groups @ 45 Minutes

CPAP (Buble, Ventilator), High Flow and Low Flow Putri Maharani/Ns. Dian Anggur

Nasal IMV Adhi TP

SiPAP and Nasal HFO Rinawati Rohsiswatmo

15.35 - 16.00 Coffee Break16.00 - 16.30 Summary

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BASIC MECHANICAL VENTILATION IN NEWBORN INFANTS

DATE One Day Program on Saturday, 24 February 2018

PLACE Hotel Santika Premiere Bintaro – Tangerang Selatan

COURSE DIRECTOR Dr. Rinawati Rohsiswatmo, dr, SpA(K) - (Jakarta)

PROGRAM

DAY 2 SATURDAY, 24 FEBRUARY 2018 INSTRUCTOR08.00 - 08.15 Opening08.15 - 08.45 Basic Principles of Mechanical Ventilation Adhi TP

08.45 - 09.15 Initial Setting and Adjusting Rinawati Rohsiwatmo

09.15 - 09.45 Ventilator Modes and Wave Forms Adhi TP

09.45 - 10.15 Coffee Break10.15 - 11.00 Volume Guarantee Adhi TP

11.00 - 11.30 Weaning Strategies Rinawati Rohsiwatmo

11.30 - 12.00 Blood Gas Analysis Rosalina Roeslani

12.00 - 13.00 Lunch13.00 - 13.30 Nursing Care of Ventilated Babies and Troubleshooting Ns. Selly Ramadhani

13.30 - 15.45 SKILL STATIONDivided in to 3 groups @ 45 Minutes

Volume Guarantee Rosalina Roeslani

Interpretation of Wave Forms Adhi TP

Initial Setting and Adjusting Rinawati Rohsiswatmo

15.45 - 16.10 Coffee Break

16.10 - 16.30 Summary

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BASIC MECHANICAL VENTILATION IN NEWBORN INFANTS: CLINICAL PRACTICE

DATE One Day Program on Sunday, 25 February 2018

PLACE Hotel Santika Premiere Bintaro – Tangerang Selatan

COURSE DIRECTOR Dr. Rinawati Rohsiswatmo, dr, SpA(K) - (Jakarta)

PROGRAM

DAY 3 SUNDAY, 25 FEBRUARY 2018 INSTRUCTOR08.00 - 08.15 Opening08.15 - 08.45 Ventilation Management in RDS Babies Adhi TP

09.15 - 09.45 Management of MAS Rosalina Roeslani

09.15 - 09.45 Management of PPHN Putri Maharani

09.45 - 10.30 Coffee break10.30 - 11.00 Principle of HFOV Rinawati Rohsiwatmo

11.00 - 11.30 HFOV in Specifi c Diseases : CDH, Hidrops, etc Rinawati Rohsiwatmo

11.30 - 12.00 Extensive Use of Surfactant Therapy Adhi TP

12.00 - 13.00 LunchCASE STUDIES

Divided into 2 groups (@ 60 mins)

13.00 - 14.00 Case Studies Conventional MV Adhi TP/Rosalina Roeslani

14.00 - 15.00 Case Studies HFOV Putri Maharani/RinawatiRohsiswatmo

15.00 - 15.30 Summary and Wrap Up

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REGISTRATION & ACCOMMODATION

HOW TO REGISTER1. Fax the Registration Form to +6221. 29315471 or Email to secretariat@picunicu.org along with proof of

payment (e.g. copy of bank transfer slip). 2. Payment Proof is strongly recommended to be done along with your Registration Form submission.

Photocopied forms are acceptable.3. You may bring your payment proof as foreseen at the Re-Registration counter. Essentially, the name tag

issued is an initial confi rmation of registrants.

REGISTRATION CONFIRMATIONParticipants are strongly suggested to make Re-Confi rmation due to incoming facsimiles/Email and/or payment made to our Registration Department, hotline numbers at offi ce hours.

Confi rmation Hotline: 021. 29315470 / 0811882080 / 0819882080

WHO SHOULD ATTENDSpecialists and Health Practitioners-whose interested in Pediatric and Neonates Intensive and Critical Care,such as Specialists Neonates Intensivist • Pediatric Intensivist; Respiralogy; Hematology; Infectious Diseases;Neurology; Nutrition & Metabolism; Gastroenterology; Immunology; Cardiology • Pediatric Surgery • Pediatric Anesthesiologists • Trainee • Emergency Doctors • General Practitioners

CERTIFICATIONAccredited by IDI & CPD IDAI

COURSE CAPACITYLimited to 60 participants/batch

REGISTRATION INFO• Registration per batch will be closed 2 weeks before workshop held. No On-Site.• Registration Form could be obtained via Secretariat Ex-Offi cio contact numbers or email to secretariat@

picunicu.org • Allocation per batch would be made upon fi rst come fi rst payments. Secretariat Ex-Offi cio reserves the

rights to accommodate the participants to the next batch due to the full-seats• Registration confi rmation is a must after registration payments. Secretariat Ex-Offi cio reserves the right not

to guarantee any seats for any unconfi rmed registrations in the workshop held.• Registration payment proof (copy is eligible) must be shown when re-register • Re-Registration service will be handed out since 07.00 morning on the fi rst day of workshop at the venue• Certifi cate will be handed out to the participants at the end of the workshop with the pre and post-test

requirements

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CANCELLATION POLICY REGISTRATION

• Any cancellation or replacement must be conveyed to the Secretariat Ex-Officio in written at the latest 7 (seven) days prior the workshop dates without charge and changeable for substitution name and/or next batch allocation.

• An administrative fee 20% of the registration fee will be charged for cancellation 7 (seven) days prior the workshop held and still changeable for substitution name and/or next batch allocation.

• Any replacement/substitution name on the workshop dates will be preceded as a new chargeableregistration.

• No show on workshop dates would be considered as cancellation without refund.

ACCOMMODATION • Hotel room rate is net for room only. • Please note that offi cial 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 168 hours prior to arrival. After the date, guaranteed payment for 1night will be charged.

• No Show will be applied on the fi rst night for delayed or postpone staying that causes the loss of 1 nightroom 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. Offi cial letter should be submitted toSecretariat address mentioning its payer’s Bank Account.

RE-REGISTRATION SERVICE The Re-Registration will be handed out to the participants from registration counters during the opening hours

at 07.00 – 09.00 on the fi rst day of the course schedule

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Notes

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REGISTRATION & ACCOMMODATION FORM

PARTICIPANTT (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 : _________________________________________________________________________________________

REGISTRATION (kindly √ appropriate box)

PERIOD REGULER COURSE NAME FIELD IDRFri-Sat, 14 – 15 July 2017Manado Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000

Fri, 15 September 2017Palembang Diffi cult Airway in Critically ill Children PICU 2.000.000

Sat-Sun, 16–17 September 2017Palembang Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000

Sat-Sun, 28 – 29 October 2017Medan Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000

Sat-Sun, 18 – 19 November 2017Balikpapan Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000

Fri, 08 December 2017Jakarta Diffi cult Airway in Critically ill Children PICU 2.000.000

Sat-Sun, 09–10 December 2017Jakarta Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000

Fri, 23 February 2018Tangerang Diffi cult Airway in Critically ill Children PICU 2.000.000

Sat-Sun, 24–25 Februari 2018Tangerang Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000

Sat-Sun, 24–25 Februari 2018Tangerang Post Resuscitation - Stabilization Management PICU 2.500.000

Sat-Sun, 24–25 Februari 2018Tangerang Comprehensive Pediatric Sepsis Management PICU 2.500.000

Fri, 23 February 2018Tangerang Basic NIV in Newborn Infants NICU 2.000.000

Sat, 24 February 2018Tangerang Basic Mechanical Ventilation in Newborn Infants NICU 2.000.000

Sun, 25 February 2018g gTangerang Basic Mechanical Ventilation in Newborn Infants: Clinical Practice NICU 2.000.000

*10% discount for Indonesian Pediatric Critical Care Foundation’s Member

SEKRETARIATThe Indonesian Pediatric Critical Care FoundationNAYA Kemang Selatan Kav. 15Jl. Madrasah Raya No 11 G-H, Kemang Ampera,Jakarta Selatan, 12560 • INDONESIAWebsite: http://www.picunicu.orgEmail: secretariat@picunicu.orgMobile : +62 811 88 2080 . +62 819 88 2080 Tlp : +62 21 293 15 470 (Hunting)Fax : +62 21 293 15 471

Nama Bank : CIMB NiagaNo. Rekening : 8000 4815 9300Cabang : Kebon Sirih JakartaAtas Nama : GEO convex

PAYMENT BY (Kindly √ appropriate circle)

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REGULAR COURSE 2017-2018

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SEKRETARIATThe Indonesian Pediatric Critical Care FoundationNAYA Kemang Selatan Kav. 15Jl. Madrasah Raya No 11 G-H, Kemang Ampera, Jakarta Selatan, 12560 • INDONESIAWebsite: http://www.picunicu.orgEmail: secretariat@picunicu.orgMobile : +62 811 88 2080 . +62 819 88 2080 Tlp : +62 21 293 15 470 (Hunting)Fax : +62 21 293 15 471

Nama Bank : CIMB NiagaNo. Rekening : 8000 4815 9300Cabang : Kebon Sirih JakartaAtas Nama : GEO convex

PAYMENT BY (Kindly √ appropriate circle)

REGISTRATION & ACCOMMODATION FORM

PARTICIPANTT (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 : _________________________________________________________________________________________

ACCOMMODATIONHOTEL NAME IDR

Swiss-Belhotel Maleosan Manado 650.000,- net/night

Aryaduta Hotel Palembang 700.000,- net/night

Grand Swiss-Belhotel - Medan 825.000,- net/night

Grand Jatra Hotel - Balikpapan 825.000,- net/night

Santika Premiere Hotel Bintaro - Tangerang 700.000,- net/night

Check In Date: Check Out Date:

Total Night(s):

Total Accommodation Payment: IDR