9th APSIC Training Course in Infection Control

24th July– 03rdAugust 2017

For Official Use
Receipt No:
Processed by:
Date:
REGISTRATION FORM
Delegate’s Information(Information will be used for Badge and Certificate Printing)
Salutation: Prof A/Prof Dr Mr Mrs Mdm Ms
Name:
(Please print in CAPITALS and underline your Family/Last Name)
MCR/SNB No.:(For Singapore Registered Doctors / Nurses Only)
*Local nurses to note: Kindly fill in your new registration number as in SNB for us to submit the CPE points for you
Institution/Dept: Country:
Mailing Address*For posting of Certificate:
Contact Number:( ) Fax: ()
Email Address:
Alternative Email :
Do you wish to participate in the hospital visit on 03 Aug 2017? Yes No

Registration Fees (Please tick  accordingly)

Category / Early Bird Rate (By 24March 2017) / Normal Rate (From 25March 2017)
Membership / ICAS Members / Non-Members / ICAS Members / Non-Members
Nurses and Paramedical / S$1250
(S$1337.50 w/GST) / S$1500
(S$1605 w/GST) / S$1500
(S$1605 w/GST) / S$1750
(S$1872.50 w/GST)
Doctors and Administrators / S$1750
(S$1872.50 w/GST) / S$2000
(S$2140 w/GST) / S$2000
(S$2140 w/GST) / S$2250
(S$2407.50 w/GST)

Payment of Registration(Please tick  one of the options)

Cheque / Bank Draft +

Cheque / Bank Draft, in Singapore xDollars, should be crossed and made payable to “Infection Control Association (Singapore)”. Kindly write the delegate’s name on the reverse side of the Cheque / Bank Draft and mail it to our conference secretariat, together with this completed form.

Invoice / Sponsor +

Co. / Institution:

Department:

Contact Person:

Contact No:

Email:

Registration Notes

  1. Your registration will only be confirmed upon receiving your payment. An official receipt will be sent to you within 10 working days upon receiving your payment.
  2. Pre-registration closes on 17th July 2017. The organizing committee regrets that submissions received after this date will be considered as on-site registration and might not receive their conference collaterals.
  3. ICAS Members need to be active members for more than 6 months in order to enjoy course fees discount.

Cancellation Policy

  1. Request for cancellation/replacement must be made in writing to the Conference Secretariat, latest by 27th July2017. The organising committee regrets that requests received after this date will not be entertained.
  2. Please take note that refunds (less 10% for administrative charges) will be issued after the event.

+ Please delete where applicable

9th APSIC Course Conference secretariat

c/o Wizlink Consulting Pte Ltd

12 West Coast Walk, #02-06, Singapore 127157

Tel: (65) 6774 5201● Fax: (65) 6774 5203● Website: Email: