The 3rd Congress and 7th Annual Meeting of Indonesian Orthopedic Society

for Sports Medicine and Anthroscopy (IOSSMA)

“Orthopaedic Sports Update from Shoulder to Foot & Ankle
New Perspectives in Diagnosis & Surgical Technique”
THE 3RD CONGRESS AND 7TH ANNUAL MEETING OF
ACCOMMODATION FORM COMMITTEE INDONESIAN ORTHOPEDIC SOCIETY
PARTICIPANT (Kindly Completed) PATRON - SCIENTIFIC - - FUNDRAISER - - WORKSHOP FOR SPORTS MEDICINE AND ARTHROSCOPY (IOSSMA)
Academic Title : □ Prof / □ DR / □ Dr / □ Specialist / □ Other Prof. Errol U. Hutagalung, MD COORDINATOR COORDINATOR JOINT INJECTION -
Orthopaedic Sports Update From Shoulder to Foot & Ankle
Prof. Idrus A. Paturusi, MD, PhD Andri M. T. Lubis, MD, PhD IGM Febry Siswanto, MD COORDINATOR
Full name : Prof. Putu Astawa, MD, PhD
VICE COORDINATOR : VICE COORDINATOR : Ronny Sutanto, MD
Organization/ Institution : S. Dohar A. L. Tobing, MD
New Perspectives in Diagnosis & Surgical Technique
Bobby N. Nelwan, MD Henry Suhendra, MD VICE COORDINATOR :
Mailing Address : MEMBERS MEMBERS Hanif Fahmat, MD
PRESIDENT OF IOSSMA 2016 – 2019
Country : IGM Febry Siswanto, MD John C. H. P. Butar Butar, MD, PhD A Djarot Noersasongko, MD MEMBERS
Iman Widya Aminata, MD Julia Kveta Wurarah, MD Athiyah Sulistiani, MD
Zip Code : Husnul Fuad Albar, MD
Ihsan Oesman, MD Ariyanto Arief, MD
Phone (Mobile) : CHAIRMAN Andri Primadhi, MD Alvarez Z. Moningka, MD
Isa An Nagib, MD
E-mail : Troydimas Panjaitan, MD
Sponsor :
Astuti Pitarini, MD - WORKSHOP CADAVER -
VICE CHAIRMAN Yudistira P. Siregar, MD
Jafri Hasan, MD COORDINATOR
Phone (Mobile) : Erica Kholine, MD Ghuna Arioharjo Utoyo, MD
Charles Hoo, MD
SECRETARY Nadia Nastassia Ifran, MD VICE COORDINATOR :
Please mark ( ) on the Hotel you choose Muhammad Sakti, MD, PhD
Renaldi P.H. Nagar Rasyid, MD Erick Wonggokusuma, MD
Evan, MD MEMBERS
HOTEL TYPE ACCOMODATION FEE IGN Wien Aryana, MD
TREASURE Sapto Adji H, MD
The Ritz – Carlton Hotel Mega Kuningan, Jakarta Grand Room □ IDR 1.850.000 Taufin Warindra, MD
Lia Marliana, MD
Jefri Sukmawan, MD Yanuarso, MD
CHECK - IN DATE: CHECK - OUT DATE: TOTAL NIGHT(S): Didi Hertanto, MD
TOTAL IDR Wahyu Riansyah, MD
I Wayan Murjana, MD
* TERM & CONDITION
1. Hotel room rate is net including 2 (two) breakfast.
2. Please note that official check in time is 15.00 local time and check out time is 12.00 local time.
3. Approval of early check-in and late check-out is at discretion of the hotel.
4. Written cancelation received before August 1st 2019 refund of 50% and after August 1st 2019 no refund.
5. For hotel services not included in the package, will be charged via personal account when check-out by the hotel.

PAYMENT BY SIGNATURE
Bank Name : MANDIRI
Acc. No : 167.00.0286889.0
Acc. Name : IOSSMA
Swift Code : BMRIIDJA

Please quote the sender’s name on the bank transfer statement

When transmitting, please make sure who send the money possibly by fax

THIS FORM TOGETHER WITH THE REQUISITEMENT PAYMENT AND/OR DOCUMENTATION SHOULD BE EMAILED/FAXED iossma2019@gmail.com
TO SECRETARIAT:
Phone: +62217254424, +62217229339, +628111332664, +628111662664 | Fax: +6221 – 7396261
Email : erlin@gpdindonesia.com | iossma2019@gmail.com
Indonesian Orthopedic Society
for Sports Medicine and Arthroscopy (IOSSMA)
Gedung Menara Era, Lantai 8, Unit 8-04 Jl. Senen Raya
No. 135 - 137, Senen, Jakarta Pusat 10410
Phone : +62 21 7254424 / 7229339 Fax: + 62 21 7396261
Contact : Ms. Erlin (+628111332664, +628111662664)
E-mail : erlin@gpdindonesia.com, iossma2019@gmail.com

The Ritz – Carlton Hotel Mega Kuningan, Jakarta | September 3rd - 6th, 2019
 The 3rd Congress and 7th Annual Meeting of Indonesian Orthopedic Society The 3rd Congress and 7th Annual Meeting of Indonesian Orthopedic Society
for Sports Medicine and Anthroscopy (IOSSMA) for Sports Medicine and Anthroscopy (IOSSMA) The 3rd Congress and 7th Annual Meeting of Indonesian Orthopedic Society
“Orthopaedic Sports Update from Shoulder to Foot & Ankle “Orthopaedic Sports Update from Shoulder to Foot & Ankle for Sports Medicine and Anthroscopy (IOSSMA)
New Perspectives in Diagnosis & Surgical Technique” New Perspectives in Diagnosis & Surgical Technique” “Orthopaedic Sports Update from Shoulder to Foot & Ankle
New Perspectives in Diagnosis & Surgical Technique”

GREETING FROM US,

REGISTRATION FORM
PARTICIPANT (Kindly Completed)
Dear Friends and Colleagues, CADAVERIC WORKSHOP SYMPOSIUM Academic Title : □ Prof / □ DR / □ Dr / □ Specialist / □ Other
We cordially invite you for The 3rdcongress And 7th
Annual Meeting Indonesian Orthopedic Society for Sports Medicine and Shoulder & Elbow Full name :
Arthroscopy (IOSSMA) with the theme "Orthopedic Sport Update From Shoulder to Foot & Ankle New Perspectives in Diagnosis and Cadaveric Knee, Foot & Ankle - September 3rd, 2019 Organization/ Institution :
Hip and Knee Sports Injury
Surgical techique" will be held at the Ritz-Carlton Hotel Mega Kuningan Jakarta - Indonesia and held on 3 - 6 September 2019. Joint Injection - September 3rd, 2019 Mailing Address :
Foot & Ankle
This meeting is held annually, so that we as colleagues can meet to discuss, exchange Cadaveric Shoulder - September 4th, 2019 Live Surgery Country :
information and share knowledge in the field of sports injuries and treatment, which this time Zip Code :
will be more discussion about the injury on the field of shoulder, foot and ankle.
Phone (Mobile) :
Annual Event meeting this time support experts shoulder, foot and ankle of the AANA,AAC E-mail :
and ASSA and have been getting approved from ISAKOS. Sponsor :
In addition to scientific events, we also invite and expect the presence of colleagues,
especially members IOSSMA to attend the congress for election of the President IOSSMA
FACULTY MEMBERS Phone (Mobile) :

2022-2025 period. INTERNATIONAL SPEAKERS NATIONAL SPEAKERS Please mark ( ) on the Workshop you choose
Until we meet in September 2019 in Jakarta. Thank you. Bruce Reider (USA) Andre Pontoh IGM Febry Siswanto Muhammad Sakti
REGISTRATION FEE
Jae Hoon Ahn (Korea) Andri M.T. Lubis IGN Wien Aryana Nadia Nastassia Ifran NO CADAVERIC WORKSHOP DATE
With Sincerely regards IGM Febry Siswanto, MD Chen Shiyi (China) Andri Primadhi Ihsan Oesman Renaldi P.H. Nagar Rasyid MEMBER NON MEMBER
I Gusti Made Febry Siswanto, MD President of IOSSMA 2016 - 2019 □ IDR 11,500,000 □ IDR 15,000,000
Hiroyuki Sugaya (Japan) Bobby N. Nelwan Iman Widya Aminata Sapto Adji H. 1 Cadaveric Knee, Foot & Ankle (24 Participants) September 3rd, 2019
In Ho Jeon (Korea) Didi Hertanto Isa An Nagib Taufin Warindra 2 Joint Injection September 3 , 2019
rd □ IDR 1,000,000
Jae Chul Yoo (Korea) Dimas Raditya Boedijono Jafri Hasan Troydimas Panjaitan 3 Cadaveric Shoulder (24 Participants) September 4 , 2019
th □ IDR 9,000,000 □ IDR 11,000,000
Jin Woo Lee (Korea) Ghuna Arioharjo Utoyo Jefri Sukmawan Wahyu Riansyah TOTAL IDR
Yong Min Chun (Korea) Hermawan Nagar Rasyid John C. H. P. Butar Butar Yanuarso Please Mark (√) on Symposium you choose
Two Speakers from AANA Husnul Fuad Albar Lia Marliana Yudistira P. Siregar
Dear Friends and Colleagues, (Arthroscopy Association of REGISTRATION FEE
NO PARTICIPANT
Welcome to Jakarta ! It is an honor and privilege to have You join Us for 3 Congress and 7 Annual Meeting of Indonesian
rd th North America) < JULY 1ST 2019 > JULY 1ST 2019
Orthopedic Society for Sports Medicine and Arthroscopy (IOSSMA) which will be held on September 3rd – 6th 2019 in The Ritz – □ IDR 3,000,000 □ IDR 3,500,000
1 Member
Carlton Hotel Mega Kuningan, Jakarta.
2 Non Member □ IDR 4,000,000 □ IDR 4,500,000
The theme of this meeting is “Orthopedic Sports Update From Shoulder to Foot & Ankle. New Perspective in Diagnosis and Surgical OTHERS
Technique”. And will be held in 4 days, consist of two days Knee and Shoulder cadaveric workshop and two days symposium.
3 Non Orthopedic Specialist □ IDR 2,000,000 □ IDR 2,250,000
The 3rd Congress and 7th Annual Meeting of IOSSMA will provides a variety of new and cutting edge surgical techniques and
approaches from Expert National and International Speakers. And in this meeting so many speakers will share a knowledge and a new GENERAL INFORMATION 4 GP / Resident
5 Physiotherapist
□ IDR 1,500,000
□ IDR 1,500,000
techniques and treatment about orthopedic sports medicine and arthroscopy, and we can learn
the latest advancements in arthroscopy, and sports medicine. TOTAL IDR
Venue : The Ritz – Carlton Hotel Mega Kuningan, Jakarta
CANCELLATION AND REFUND POLICY
Jakarta, officially the Special Capital Region of Jakarta is the capital and largest city of Indonesia.
Written cancellation notice is required. Cancellation must be received before August 1st 2019 refund of 50% and after
It is located on the northwest coast of the world's most populous island, Java. Jakarta have
August 1st 2019 no refund
popular heritage tourism in Kota area, it is the centre of old Jakarta, with its Maritime Museum,
Kota Intan drawbridge, Wayang Museum, Stadhuis Batavia, Fine Art and Ceramic Museum, IMPORTANT DATE PAYMENT BY SIGNATURE
Bank Indonesia Museum.
Bank Name : MANDIRI
Special local cuisine and one of the most popular local dishes of Betawi cuisine is Soto Betawi, Cadaveric Workshop Acc. No : 167.00.0286889.0
Acc. Name : IOSSMA
which is prepared from chunks of beef and offal in rich and spicy cow's milk or coconut milk • Cadaveric Knee, Foot & Ankle - September 3rd, 2019 Swift Code : BMRIIDJA
broth. Other popular Betawi dishes include nasi uduk, kerak telor (spicy omelette), asinan,
ketoprak, rujak and gado-gado Betawi (salad in peanut sauce).
• Joint Injection - September 3rd, 2019
• Cadaveric Shoulder – September 4th, 2019 Please quote the sender’s name on the bank transfer statement
Please make sure you have block your agenda for this important meeting and looking forward Isa An Nagib, MD • Early Registration – July 1st, 2019
When transmitting, please make sure who send the money possibly by fax
to meeting you in Jakarta. Chairman
THIS FORM TOGETHER WITH THE REQUISITEMENT PAYMENT AND/OR DOCUMENTATION SHOULD BE EMAILED/FAXED
With Sincerely regards, Symposium – September 5 – 6 , 2019
th th TO SECRETARIAT:
Phone: +62217254424, +62217229339, +628111332664, +628111662664 | Fax: +6221 – 7396261
Isa An Nagib, MD Email : erlin@gpdindonesia.com | iossma2019@gmail.com