CSSD 2019 Registration Form – Infection Control Association (Singapore)

Salutation*

Full Name*

First

Last

Profession*

MCR/SNB No.

Institution/Department*

Designation*

Mailing Address

Street Address City State / Province / Region Postal / Zip Code Country

Contact No.*

Fax

Email*

Do you wish to participate in the hospital visit on 6 November 2019?*

Yes

No

Dietary Requirement*

No Pork, No Lard

Vegetarian

Registration Fee*

ICA(S) Member - Early Bird (Till 13 July 2019)

Non ICA(S) Member - Early Bird (Till 13 July 2019)

Total

Payment Options*

Cheque / Bank Draft

Invoice / Sponsor

All course fees can be made by cheques or bank draft, made payable to “Infection Control Association (Singapore)”. Cheques or Bank Drafts are to be mailed to the Secretariat. All payment is to be made in SINGAPORE DOLLARS and a receipt will be issued within 10 days of payment. Kindly write the delegate’s name on the reverse side of the Cheque / Bank Draft and mail it to our conference secretariat.

Invoice / Sponsor

Co. / Institution*

Address*

Street Address Postal / Zip Code

Department*

Contact Person*

Contact No. *

Email *

Registration Notes

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.
Early Bird registration closes on 13^th July 2019. The organizing committee regrets that submissions received after this date will be considered as on-site registration and might not receive their conference collaterals.
ICAS Members need to be active members for more than 6 months in order to enjoy course fees discount.

Cancellation Policy

Request for cancellation/replacement must be made in writing to the Conference Secretariat,
latest by 30^th October 2019. The organising committee regrets that requests received after this date will not be entertained.
75% of the course fees will be refunded upon successful cancellation within two months after the course.