Registration Form for International Delegate

Title: Prof    Dr    Mr    Mrs    Ms   
Given Name:
Family Name:
IC or Passport No:
Preferred Name on Badge/Certificate:
Affiliated Organisation:
Mailing Address:
 
Postal Code :
City:
Country:
Telephone:
Mobile:
Fax:
Email:
Dietary Requirements (if any) :

Registration Fees

Two-day course (28 - 29 November 2009)		    
Main Congress
 Delegates Trainees and Students*
Early-bird Registration (by 30 September 2009) S$200.00   S$80.00
Normal Registration ( from 01 October 2009) S$250.00 S$100.00
*Please attach a letter from Head of Department to confirm your Trainee/student status.

Payment

My total payment of S$ will be made via Cheque* Visa Mastercard

Cheque should be payable to “Ping Healthcare Pte Ltd”.
Please complete this form and mail together with the bankdraft to: Ten Topics Asia Secretariat - Ping Healthcare Pte Ltd
5 Upper Aljunied Link, #05-05, Quartz Industrial Building, Singapore 367903
Tel: (65) 6778 5620 Fax: (65) 6778 1372

Notes

 
IMPORTANT
  • Please use one form per participant.
  • An official confirmation of registration will be sent to you upon receipt of your registration form and clearance of payment.
  • Please keep your official confirmation of registration as it must be produced at the registration counter at the congress to obtain your name badge.
 
PAYMENT MODES

All fees must be paid in Singapore Dollars by Cheque, Visa or Mastercard. On-site registration may be paid for in cash. Relevant bank charges for international cheque payments will be applied.

 
CANCELLATION POLICY

On written request, a refund will be issued, but an administration charge of S$50 will be subtracted.
No refunds will be made after 09 October 2009.