Advanced Course in Problem Solving Registration – Infection Control Association (Singapore)

Salutation:*

Name:*

First

Last

MCR/SNB No. :*

Profession: *

Doctor

Nurse

Pharmacist

Others

Institution/Dept:*

Mailing Address: *

Street Address Postal / Zip Code Country

Contact No.:*

Fax:

Email:*

Registration Fees:*

ICAS Members - Early Bird Rate (SGD$200)

ICAS Members - Normal Rate (SGD$260)

Non-Members - Early Bird Rate (SGD$230)

Non-Members - Normal Rate (SGD$320)

Early Bird Rate - Until 4 June 2018

Normal Rate - From 5 June 2018 onwards

Kindly note that for member rates, member must have been with the society for at least 6 months (subject to verification)

Payment of Registration:*

Cheque/Bank Draft

Cheque / Bank Draft, in Singapore Dollars, 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 - Co./Institution:*

Invoice - Department:*

Invoice - Mailing Address:*

Street Address Postal / Zip Code Country

Invoice - Contact Person:*

Invoice - Contact No.:*

Invoice - Email:*

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