A N NOU NCE M ENT -...

T H E I N D O N E S I A N F O U N D A T I O N O F U R O L O G Y D E V E L O P M E N T

( Y A Y A S A N P E N G E M B A N G A N U R O L O G I I N D O N E S I A )

A N N O U N C E M E N T

Andro-Urology & Men’s Health

THE 34TH FIESTA UROLOGI 2017

Grand City Convex Surabaya, July 29th - 30th, 2017

PCNL Workshop

InaSAU Microsurgery Workshop

Urological Nurse Symposium & Workshop

Muktamar Luar Biasa IAUI

In UINDONESIAN SOCIETY OFANDROLOGICAL UROLOGY

IKAT

AN AHLI UROLOGI

INDONESIA

AC

CREDITATI O

N

AC

CREDITATI O

N

Dear Colleagues,We are delighted to welcome you to city of heroes, Surabaya, in 26th – 30th July, 2017. Symposium will be held in Grand City Convex Surabaya, which islocated in the heart of the city. 34th Fiesta Urology is about Andro-urology and Men’s Health. We will have panel discussion, lecture, symposium highlighting new guideline, breakthrough research and technology in Men’s Health. In this week, we will have workshop in PCNL as a regular basis of Fiesta Urology and Microsurgery to enhance the skill of andro-urology procedure. We hope this annual Fiesta Urology can improve not only our skill and knowledge, but also our bond as family in Indonesian Urological Association. Best regards,

Fikri Rizaldi, MD (Urol.)

C H A I R M A N

G R E E T I N G

THE 34TH FIESTA UROLOGI 2017THE 34TH FIESTA UROLOGI 2017 1

CONTENT1GREETING

2COMMITTEE

3SECRETARIAT

4GENERAL INFORMATION

5PRE SYMPOSIUM - WORKSHOP

7SYMPOSIUM

9REGISTRATION & ACCOMMODATION INFORMATION

1 0REGISTRATION FORM

1 1ACCOMMODATION FORM

C O M M I T T E E

THE 34TH FIESTA UROLOGI 2017THE 34TH FIESTA UROLOGI 2017 32

S E C R E T A R I A T

CO ORGANIZER

PT. GPD Indonesia

Jl. Kebalen V No. 24 A Kebayoran Baru

Jakarta Selatan 12180

Telp: +62 21 7254424, +62 21 7229339

Reg by SMS: +628111332664, +628111662664

Fax: +62 21 7396261

Email: [email protected] / [email protected]

CP: Erlin

ORGANIZER

Sekretariat

Departemen/SMF Urologi

FK. UNAIR/RSUD dr. Soetomo Surabaya

Jl. Mayjend. Prof. dr. Moestopo no. 6-8 Surabaya 60286

Telp: +62 31 5501318; Fax: +62 31 5024971

HP: +6285731333449

CP: Hadi

Email: [email protected]

PELINDUNG :

Pengurus Pusat Ikatan Ahli Urologi Indonesia

PENASEHAT :

Ketua Departemen Urologi FK Unair Surabaya

Ketua IAUI Cabang Jawa Timur

STEERING COMMITTEE :

Dr. Wahjoe Djatisoesanto,dr., SpU-K

Prof. Dr. Sunaryo Hardjowijoto, dr., SpB, SpU-K

Prof. Dr. Doddy M. Soebadi, dr., SpB, SpU-K

Prof. Dr. Soetojo, dr., SpU-K

Dr. Adi Santoso, SpB, SpU-K

Dr. Tarmono, dr., SpU-K

Dr. Lukman Hakim, SpU, MARS, PhD

Dr. M. Ayodhia Soebadi, Sp.U

Dr. Johan Renaldo, Sp.U

Dr. Fikri Rizaldi, Sp.U

Dr. Anugrah Dian Fitriani, SpU

Ketua Penyelenggara : Dr. Fikri Rizaldi, SpU

Wakil : Dr. Rheza M Putra

Sekretaris : Dr. Dian Kartika Rezia

Bendahara : Dr. Yohan Afandi

Sie Acara: Dr. Aditya Pramanta l Dr. Puruhito Eko Nugroho l Dr. Dimas Visa Aditya l Dr. Bangun Oktavian l Dr. Reza Sanjaya l Dr. Achmad Kholis

Sie Ilmiah : Dr. Andri Rhomdon l Dr. Dwi Waskito l Dr. Ananta Cahyo Nugrohol Dr. Arifai Lumbangaol l Dr. Joseph Hartanta Purba l Dr. Zulfikar Dian Paradilan

Sie Workshop : Dr. I. B Pramana l Dr. Riza Mazidu l Dr. Ahmad Nugroho l Dr. Fadhila Rakhmatiar l Dr. Ari Alauddin l Dr. M. Reza Gautama

Sie Publikasi & Dokumentasi : Dr. Randa Halfian l Dr. Eldien M Shidqy l Dr. Suryo Prasetyo Tribowo l Dr. Anggana Suryatmana

Sie Perijinan & Perlengkapan : Dr. Ardhito Rahman l Dr. Aril Rizaldil Dr. Widya Sakti l Dr. Johannes Marpaung l Dr. Binsar Marshall

Sie Transportasi : Dr. Moh. Surya Negara l Dr. Ido Putra Ramadhan l Dr. Fadil Pramudya l Dr. Cahyo Wijayanto

Sie Konsumsi : Dr. Hajid Rahmadianto l Dr. Hasroni Fathurrahman l Dr. Zuhri Syawal l Dr. Adhitya Fajar Prasetya

IKAT

AN AHLI UROLOG

I

INDONESIA

THE 34TH FIESTA UROLOGI 20174 THE 34TH FIESTA UROLOGI 2017 5

G E N E R A L I N F O R M A T I O N P R E S Y M P O S I U M - W O R K S H O P

VENUE :

Grand City Convex Surabaya

Jl. Walikota Mustajab No. 1

surabaya – Jawa Timur

IMPORTANT DATE:

Wednesday – Sunday, July 26th – 30th 2017

THEME:

Andro-urology and Men’s Health

DETAIL PROGRAMME:

• Rabu - Kamis, 26 - 27 Juli 2017 : PCNL Workshop

• Jumat & Minggu, 28 & 30 Juli 2017: Microsurgery Workshop

• Sabtu, 29 Juli 2017 : Urological Nurse Symposium & Workshop

• Sabtu-Minggu, 29 - 30 Juli 2017 : Simposium

• Sabtu, 29 Juli 2017 : Malam Keakraban

• Sabtu, 29 Juli 2017 : Muktamar Luar Biasa IAUI

EXHIBITION:

July 29th – 30th, 2017

Bank Name : CIMB Niaga Cab. Dharmahusada Surabaya

Account number : 7025 - 3525 - 4000

Account name : Yayasan Pengembangan Urologi Indonesia

INTERNATIONAL SPEAKER:

Asif Muneer (London, UK)

Du Geon Moon (Korea)

Masaki Kimura (Japan)

Nam Cheol Park (Korea)

Rupin Shah (India)

See Woong Kim (Korea)

MICROSURGERY WORKSHOP, JULY 28TH & 30TH, 2017(Limited 10 Participants) - Ruang Vesica - GBPT, RSUD Dr. Soetomo, Surabaya

Friday, July 28th, 2017

Sunday, July 30th, 2017

TIME DETAIL INSTRUCTOR07.00 - 07.4507.45 - 08.00 Opening Remarks Dr. dr. Wahjoe Djatisoesanto, SpU (K)08.00 - 08.20 Instrumentations and Surgical Techniques Dr. dr. Tarmono, SpU (K)08.20 - 08.40 Access to Kidney and Complications Prof. Dr. dr. Doddy M. Soebadi, SpB, SpU (K)08.40 - 09.00 Case Selection Dr. dr. Wahjoe Djatisoesanto, SpU (K)09.00 - 09.10

09.30 - 15.00

TIME07.30 - 08.00

08.25 - 15.00

Department of Urology 2F, Prostate Room / GBPT Dr. Soetomo Hospital SurabayaPCNL WORKSHOP, JULY 26TH - 27TH 2017

(Limited 12 Participants)

Wednesday, July 26th 2017

09.10 - 09.30

Re-Registration

Q & ACoffee BreakTransfer to ORPCNL Workshop

Thursday, July 27th 2017

Re-RegistrationCoffee BreakTransfer to ORPCNL Workshop

08.00 - 08.25

DETAIL07.00 - 07.45

07.45 - 15.00 PCNL Workshop Prof. Dr. dr. Doddy M. Soebadi, SpB, SpU (K)

Dr. dr. Tarmono, SpU (K)

Dr. dr. Wahjoe Djatisoesanto, SpU (K)

TIME DETAIL INSTRUCTOR07.00 - 07.4507.45 - 08.00 Opening Remarks Dr. dr. Wahjoe Djatisoesanto, SpU (K)08.00 - 08.20 Instrumentations and Surgical Techniques Dr. dr. Tarmono, SpU (K)08.20 - 08.40 Access to Kidney and Complications Prof. Dr. dr. Doddy M. Soebadi, SpB, SpU (K)08.40 - 09.00 Case Selection Dr. dr. Wahjoe Djatisoesanto, SpU (K)09.00 - 09.10

09.30 - 15.00

TIME07.30 - 08.00

08.25 - 15.00

Department of Urology 2F, Prostate Room / GBPT Dr. Soetomo Hospital SurabayaPCNL WORKSHOP, JULY 26TH - 27TH 2017

(Limited 12 Participants)

Wednesday, July 26th 2017

09.10 - 09.30

Re-Registration

Q & ACoffee BreakTransfer to ORPCNL Workshop

Thursday, July 27th 2017

Re-RegistrationCoffee BreakTransfer to ORPCNL Workshop

08.00 - 08.25

DETAIL

PCNL WORKSHOP, JULY 26TH - 27TH, 2017

(Limited 12 Participants) - Ruang Vesica - GBPT, RSUD Dr. Soetomo, Surabaya

Prof. Dr. dr. Doddy M. Soebadi, SpB, SpU (K)

Dr. dr. Tarmono, SpU (K)

Dr. dr. Wahjoe Djatisoesanto, SpU (K)

Transfer to Operating Room

PCNL Workshop

Semi - Live Video Presentation Vineet Malhotra (India) & Masaki Kimura (Japan)

TIME DETAIL INSTRUCTOR

07.00 - 07.30

07.30 - 08.00 Course of Overview - Exercises in Microsurgery Doddy M. Soebadi

08.00 - 08.20 Percutaneus Epidymal Aspiration (PESA) and Needle Aspiration Biopsy (NAB). When and How

Vineet Malhotra (India)

08.20 - 08.40 Vasovasostomy and Vasoepididymostomy Ponco Birowo

08.40 - 09.00 Microsurgery Varicocelectomy Fikri Rizaldi

09.00 - 09.20

09.20 - 09.40 Microdenervation of Spermatic Cord Masaki Kimura (Japan)

09.40 - 10.00 Testicular Sperm Extraction (TESE) Ricky A

10.00 - 10.20 Micro-TESE Asif Muneer (London, UK)

10.20 - 11.00 Video Presentation: Microsurgical Procedure Asif Muneer (London, UK)

11.00 - 11.20 Panel Discussion G Wirya D

11.20 - 13.00

13.00 - 16.00 Paired Mentored Station in Microsurgical Procedures InaSAU

Friday, July 28th 2017

Registration

Coffee Break

Lunch and Pray


13.00 - 13.30

13.30 - 13.50 Course Overview in Wetlabs Doddy M. Soebadi

13.50 - 14.10 Carl Zeiss Presentation


16.30 - 17.00

Registration

Closing & Coffee Break


13.00 - 13.30

13.30 - 13.50 Course Overview in Wetlabs Doddy M. Soebadi

13.50 - 14.10 Carl Zeiss Presentation


16.30 - 17.00

Registration

Closing & Coffee Break

THE 34TH FIESTA UROLOGI 20176 THE 34TH FIESTA UROLOGI 2017 72017A UROLOGI 2017A UROLOGI TA UROLOGI THE 34TH FIESTHE 346

S Y M P O S I U MP R E S Y M P O S I U M - W O R K S H O P

SATURDAY, JULY 29TH, 2017


Waktu Acara07.00 - 07.15 Registration07.15 - 07.30 Opening Ceremony. Ketua IAUI

07.30 - 07.50 Clinical Investigation of the Infertile Male and Basic Semen Analysis07.50 - 08.10 Priapism Made Easy08.10 - 08.30 Buried Penis. How to Manage08.30 - 08.50 Scrotal Pain: Treatment Algorithm08.50 - 08.55 Q & A08.55 - 09.10 Coffee Break

09.10 - 09.30 Percutaneus Epidydimal Aspiration (PESA). How to Do It Properly09.30 - 09.50 Neddle Aspiration Biopsy (NAB), When and How09.50 - 10.10 TESE and Micro-TESE10.10 - 10.30 Failed TESE. What Next?10.30 - 10.35 Q & A

10.35 - 10.55 Penile Augmentation:Urologist Work?10.55 - 11.15 General Conception of Penile Girth Enhancement11.15 - 11.20 Penile Augmentation Using Filter, Injectable Hyaluronic Acid Gel11.20 - 11.40 Peyronie's Disease: Technique Selection11.40 - 12.00 Microdenervation of Spermatic Cord for Chronic Orchialgia12.00 - 12.20 Varicocelectomy and Its Alternative12.20 - 12.25 Q & A

12.25 - 12.40 Surgical Treatment: Recent Update on Open, Laparoscopic & Robotic Surgery12.40 - 12.55 The Principle of ADT: Comparing NCCN Asia Version, EAU and AUA Guidelines12.55 - 13.10 Dosage Options for ADT: What does the Evidence Say?13.10 - 13.15 Q & A

13.15 - 13.35 Obstructive and Non Obstructive Azoospermia13.35 - 13.55 Medical Treatment of NOA13.55 - 14.15 Surgical Treatment of OA14.15 - 14.35 SST Technique for Men with Testicular Failure14.35 - 14.40 Q & A

14.40 - 15.00 Patophysiology of Erectile Dysfunction15.00 - 15.20 Treatment of ED15.20 - 15.40 Shah Penile Prosthesis. Tips and Tricks to Do It Properly15.40 - 15.45 Q & A15.45 - 16.00 Coffee Break16.00 - 17.00 Muktamar Luar Biasa IAUI17.00 - 18.00 Rapat IAUI Cabang Jawa Timur19.00 - 21.00 Malam Keakraban

Sesi 3. Operative Andrology

Sesi 4. Lunch Symposium: Localized and Locally Advanced Prostate Cancer

Sesi 5. Azoospermia

Sesi 6. Erectile Dysfunction

Saturday, July 29th 2017

Sesi 1. Basic and Emergency Andrology

Sesi 2. Sperm Retrieval

Time Topic

07.30 - 08.30 Registration

08.30 - 08.50 Illustrative Procedure of Urinary Stone Disease: Open vs Endoscopic

08.50 - 09.10 Open Stone Surgery: What to Do & What to Expect

09.10 - 09.30 Preparation of URS and PCNL: Step by Step

09.30 - 09.50 Endoscopic Instruments: How to Properly Maintain & the Troubleshooting

09.50 - 10.00 Q & A

10.00 - 10.30 COFFEE BREAK

10.30 - 10.50 Endoscopic Management of Prostatic Enlargement

10.50 - 11.10 Preparation of TURP and Green Light Laser Photoselective Vaporization of the Prostate: How do We do It

11.10 - 11.30 Laparoscopic Surgery in Urology

11.30 - 11.50 Preparation & Troubleshooting of Urologic Laparoscopic Surgery

11.50 - 12.00 Q & A

12.00 - 13.00 LUNCH

13.00 - 14.00 Workshop I : Preparation of Uroflowmetry dan Urodynamic

14.00 - 15.00 Workshop II: Performing CIC and Preparation of TRUS + Prostate Biopsy & Post Procedural Management


UROLOGICAL NURSE SYMPOSIUM & WORKSHOP, SATURDAY, JULY 29 2017Grand City Convex Surabaya

Time Topic

08.30 - 08.50 Illustrative Procedure of Urinary Stone Disease: Open vs Endoscopic

08.50 - 09.10 Open Stone Surgery: What to Do & What to Expect

09.10 - 09.30 Preparation of URS and PCNL: Step by Step

09.30 - 09.50 Endoscopic Instruments: How to Properly Maintain & the Troubleshooting

09.50 - 10.00 Q & A

10.30 - 10.50 Endoscopic Management of Prostatic Enlargement

10.50 - 11.10 Preparation of TURP and Green Light Laser Photoselective Vaporization of the Prostate: How do We do It

11.10 - 11.30 Laparoscopic Surgery in Urology

11.30 - 11.50 Preparation & Troubleshooting of Urologic Laparoscopic Surgery

11.50 - 12.00 Q & A

13.00 - 14.00 Workshop I : Preparation of Uroflowmetry dan Urodynamic

14.00 - 15.00 Workshop II: Performing CIC and Preparation of TRUS + Prostate Biopsy & Post Procedural Management

Waktu Acara

08.55 - 09.10 Coffee Break


07.00 - 07.15 Registration07.15 - 07.30 Opening Ceremony. Ketua IAUI

16.00 - 17.00 Muktamar Luar Biasa IAUI17.00 - 18.00 Rapat IAUI Cabang Jawa Timur19.00 - 21.00 Malam Keakraban

07.30 - 07.50 Clinical Investigation of the Infertile Male and Basic Semen Analysis07.50 - 08.10 Priapism Made Easy08.10 - 08.30 Buried Penis. How to Manage08.30 - 08.50 Scrotal Pain: Treatment Algorithm08.50 - 08.55 Q & A

Sesi 1. Basic and Emergency Andrology

10.35 - 10.55 Penile Augmentation:Urologist Work?10.55 - 11.15 General Conception of Penile Girth Enhancement11.15 - 11.20 Penile Augmentation Using Filter, Injectable Hyaluronic Acid Gel11.20 - 11.40 Peyronie's Disease: Technique Selection11.40 - 12.00 Microdenervation of Spermatic Cord for Chronic Orchialgia12.00 - 12.20 Varicocelectomy and Its Alternative12.20 - 12.25 Q & A

Sesi 3. Operative Andrology

12.25 - 12.40 Surgical Treatment: Recent Update on Open, Laparoscopic & Robotic Surgery12.40 - 12.55 The Principle of ADT: Comparing NCCN Asia Version, EAU and AUA Guidelines12.55 - 13.10 Dosage Options for ADT: What does the Evidence Say?13.10 - 13.15 Q & A

Sesi 4. Lunch Symposium: Localized and Locally Advanced Prostate Cancer

09.10 - 09.30 Percutaneus Epidydimal Aspiration (PESA). How to Do It Properly09.30 - 09.50 Neddle Aspiration Biopsy (NAB), When and How09.50 - 10.10 TESE and Micro-TESE10.10 - 10.30 Failed TESE. What Next?10.30 - 10.35 Q & A

Sesi 2. Sperm Retrieval

13.15 - 13.35 Obstructive and Non Obstructive Azoospermia13.35 - 13.55 Medical Treatment of NOA13.55 - 14.15 Surgical Treatment of OA14.15 - 14.35 SST Technique for Men with Testicular Failure14.35 - 14.40 Q & A

Sesi 5. Azoospermia

Sesi 6. Erectile Dysfunction14.40 - 15.00 Patophysiology of Erectile Dysfunction15.00 - 15.20 Treatment of ED15.20 - 15.40 Shah Penile Prosthesis. Tips and Tricks to Do It Properly15.40 - 15.45 Q & A



12.00 - 13.00 LUNCH


Fikri Rizaldi

Fikri Rizaldi

Grand City Convention & Exhibition

Fikri Rizaldi

Fikri Rizaldi

Majapahit Garden Dinner

R E G I S T R A T I O N & A C C O M M O D A T I O N I N F O R M A T I O N

REGISTRATION BY EMAIL To get a registration form can contact the secretariat at +62 21 7254424 or +62 21 7229339 after filling the registration form can email to erlin@ gpdindonesia.com and [email protected]

REGISTRATION BY FAX Complete the registration form to the Secretariat Fax number at +62 21 7396261 and then reconfirm to secretariat at +62 21 7254424 or +62 21 7229339

ON SITE REGISTRATION Those who have not registered in advance may register at onsite registration desk. Only cash payment in Rupiah will be accepted during onsite registration. No refund will be made for onsite registration fees.

REGISTRATION PAYMENT All registration fees must be paid by bank transfer. Registrant should bear all bank charges. Please send a copy of the transaction along with the registration to the Organizing Committee.

HOTEL POLICY Due to high demand on the hotel room at the time of congress, the congress secretariat strongly recommended early reservations.

ROOM RATE Hotel rooms at special congress rate arebeing held for the congress participants atMajapahit Hotel Surabaya. Room rates are in Rupiah, per night and per room included breakfast for two persons. Reservations must be made through the congress secretariat to guarantee the indicated rate negotiates for the congress.

HOTEL RESERVATION Hotel assignment will be made on a “FIRST COME FIRST SERVE BASIS”.

REGISTRATION AND ACCOMMODATION SECRETARIATDepartment of Urology Airlangga University School of Medicine Dr. Soetomo Hospital Surabaya Mayjend Moestopo 6-8 Surabaya 60286, Indonesia Phone : +62 31 5501318 Fax : +62 31 5024971 Contact : Mr. Hadi (+62 857 31333449) Email : [email protected]

PT. GPD Indonesia Kebalen V No. 24 A, Jakarta 12180 Phone : (+62 21) 7229339, 7254424 Fax : (+62 21) 7396261 Mobile : +62 8111 332664, +62 8111 662664 Contact : Erlin Email : [email protected] [email protected]

PAYMENT BY Bank Name : CIMB Niaga Cab. Dharmahusada Surabaya

Account number : 7025 - 3525 - 4000

Account name : Yayasan Pengembangan Urologi Indonesia

Swift Code : BNIAIDJA


SUNDAY, JULY 30TH, 2017

S Y M P O S I U M

Waktu Acara07.00 - 07.30 Registration

07.30 - 07.50 miniPCNL. How small can you go07.50 - 08.10 supine PCNL with low complication08.10 - 08.30 Retrograde Intrarenal Surgery. Cost and Benefit08.30 - 08.35 Q & A

08.35 - 08.55 Medical Treatment of BPH. Monotreatment or Combination08.55 - 09.15 TURP vs Laser 09.15 - 09.35 new paradigm in BPH09.35 - 09.40 Q & A09.40 - 09.55 Coffee Break

09.55 - 10.15 Hernia Mesh for POP. Possible?10.15 - 10.35 Biological Sling. Indication and Patient Selection10.35 - 10.55 Current available treatment in Urinary incontinence10.55 - 11.00 Q & A

11.00 - 11.20 Bladder Cancer Management. Recent Update11.20 - 11.40 Instillation treatment for bladder cancer. How to enhance the effect11.40 - 12.00 Operative management and preoperative treatment.12.00 - 12.05 Q & A

12.05 - 12.20 Current biomarker for prostate cancer12.20 - 12.35 5-ARI for prostate cancer. Is it Relevant?12.35 - 12.50 Treatment of Advance Prostate cancer. When and How12.50 - 12.55 Q & A12.55 - 13.00 Closing Ceremony13.00 - 14.00 Lunch and Pray

Sesi 5. Lunch Symposium: Advanced and metastatic prostate cancer

Sunday, July 30th 2017

Sesi 1. Endourology

Sesi 2. BPH update

Sesi 3. Female Urology

Sesi 4. Bladder Cancer

Waktu Acara


12.05 - 12.20 Current biomarker for prostate cancer12.20 - 12.35 5-ARI for prostate cancer. Is it Relevant?12.35 - 12.50 Treatment of Advance Prostate cancer. When and How12.50 - 12.55 Q & A

Sesi 5. Lunch Symposium: Advanced and metastatic prostate cancer

12.55 - 13.00 Closing Ceremony13.00 - 14.00 Lunch and Pray


07.30 - 07.50 miniPCNL. How small can you go07.50 - 08.10 supine PCNL with low complication08.10 - 08.30 Retrograde Intrarenal Surgery. Cost and Benefit08.30 - 08.35 Q & A

Sesi 1. Endourology

09.55 - 10.15 Hernia Mesh for POP. Possible?10.15 - 10.35 Biological Sling. Indication and Patient Selection10.35 - 10.55 Current available treatment in Urinary incontinence10.55 - 11.00 Q & A

Sesi 3. Female Urology

11.00 - 11.20 Bladder Cancer Management. Recent Update11.20 - 11.40 Instillation treatment for bladder cancer. How to enhance the effect11.40 - 12.00 Operative management and preoperative treatment.12.00 - 12.05 Q & A

Sesi 4. Bladder Cancer

08.35 - 08.55 Medical Treatment of BPH. Monotreatment or Combination08.55 - 09.15 TURP vs Laser 09.15 - 09.35 new paradigm in BPH09.35 - 09.40 Q & A

Sesi 2. BPH update

A C C O M M O D A T I O N F O R M

CANCELLATION AND REFUND POLICYWritten Cancellation notice is required. Cancellation must be received before July 1ST 2017 a 50% refund will be returned after congress ended. No refund will be allowed thereafter

PAYMENT BYq BANK TRANSFER Bank Name : CIMB Niaga Cab. Dharmahusada SurabayaAccount number : 7025 - 3525 - 4000Account name : Yayasan Pengembangan Urologi Indonesia

Please quote the sender’s name on the bank transfer statementWhen transmitting, please make sure who send the money possibly by fax.

q CASH TO SECRETARIAT

This form, TogeTher wiTh The requisiTe paymenT and/or documenTaTion should be emailed/faxed To:Secretariat at GPD INDONESIA Jl. Kebalen V No. 24A Kebayoran Baru, Jakarta 12180

Telp. +6221 7254424 | 7229339 Reg by, SMS +628111332664 | +628111662664 Fax. +6221 7396261Email. [email protected] / [email protected] / [email protected]

S I G N A T U R E

PARTICIPANT (Kindly Completed)

Title : q Prof q DR q Dr q Specialist q Other

Full Name :

Organization/Hospital/Institution :

Mailing Address :

Country :

Zip Code :

Mobile Phone :

Email :

Sponsor :

Mobile Phone :

Please Mark (√) on Hotel you choose

THE 34TH FIESTA UROLOGI 2017 - GRAND CITY CONVEX SURABAYA, JULY 26TH - 30TH, 2017

HOTEL ROOM TYPE RATE

Majapahit Surabaya q GARDEN TERRACE q Rp. 1.300.000

CHECK – IN DATE: CHECK – OUT DATE: T OTAL NIGHT (S):

TOTAL ACCOMMODATION PAYMENT: IDR

*TERM & CONDITION• Hotel room rate is net including 2 (two) breakfast• Please note that official check in time is 15.00 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 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.

R E G I S T R A T I O N F O R M

PARTICIPANT (Kindly Completed)

Title : q Prof q DR q Dr q Specialist q Other

Full Name :

Organization/Hospital/Institution :

Mailing Address :

Country :

Zip Code :

Mobile Phone :

Email :

Sponsor :

Mobile Phone :

NO WORKSHOP DATE REGISTRATION FEE

q 1 PCNL (Limited 12 Participants)q Specialistq Nurse

JULY 26TH-27TH, 2017JULY 26TH-27TH, 2017

q Rp. 10.000.000q Rp. 3.000.000

q 2 MICROSURGERY (Limited 10 Participants)q Specialist Urology/ Residen JULY 28TH & 30TH 2017 q Rp 10.000.000

NO SYMPOSIUM & WORKSHOP DATE REGISTRATION FEE

q 1 NURSE JULY 29TH, 2017 q Rp 1.000.000

WORKSHOP - JULY 26TH - 30TH, 2017

SYMPOSIUM & WORKSHOP - JULY 29TH, 2017 (Workshop Limited 40 Participants)

CANCELLATION AND REFUND POLICYWritten Cancellation notice is required. Cancellation must be received before July 1ST 2017 a 50% refund will be returned after congress ended. No refund will be allowed thereafter

PAYMENT BYq BANK TRANSFER Bank Name : CIMB Niaga Cab. Dharmahusada SurabayaAccount number : 7025 - 3525 - 4000Account name : Yayasan Pengembangan Urologi Indonesia

Please quote the sender’s name on the bank transfer statementWhen transmitting, please make sure who send the money possibly by fax.

q CASH TO SECRETARIAT

This form, TogeTher wiTh The requisiTe paymenT and/or documenTaTion should be emailed/faxed To:Secretariat at GPD INDONESIA Jl. Kebalen V No. 24A Kebayoran Baru, Jakarta 12180

Telp. +6221 7254424 | 7229339 Reg by, SMS +628111332664 | +628111662664 Fax. +6221 7396261Email. [email protected] / [email protected] / [email protected]

S I G N A T U R E

Please Mark (√) on Workshop / Symposium you choose

THE 34TH FIESTA UROLOGI 2017 - GRAND CITY CONVEX SURABAYA, JULY 26TH - 30TH, 2017

NO PARTICIPANT DATE REGISTRATION FEE

1 Specialist JULY 29TH-30TH, 2017 q Rp. 2.500.000

2 General Practitioner JULY 29TH-30TH, 2017 q Rp. 1.000.000

TOTAL REGISTRATION SYMPOSIUM IDR

SYMPOSIUM* If Workshop Quota is Full, for Symposium only q Rp 750.000

CO ORGANIZER

PT. GPD Indonesia

Jl. Kebalen V No. 24 A Kebayoran Baru

Jakarta Selatan 12180

Telp: +62 21 7254424, +62 21 7229339

Reg by SMS: +628111332664, +628111662664

Fax: +62 21 7396261

Email: [email protected] / [email protected]

CP: Erlin

ORGANIZER

Sekretariat

Departemen/SMF Urologi

FK. UNAIR/RSUD dr. Soetomo Surabaya

Jl. Mayjend. Prof. dr. Moestopo no. 6-8 Surabaya 60286

Telp: +62 31 5501318; Fax: +62 31 5024971

HP: +6285731333449

CP: Hadi

Email : [email protected]

IKAT

AN AHLI UROLOG

I INDONESIA

A N NOU NCE M ENT -...

Documents

Transcript of A N NOU NCE M ENT -...