CANCELLATION/REPLACEMENT POLICY: Request for Cancellation/Replacement Must Be Made In

7 - 8November 2014

REGISTRATION FORMClosing Date: 24 October2014 Fax: (65) 62210944 I Email:

Prof A/Prof Dr Mr Ms
CAP SURNAME (Last Name) / First Name (Given Name)
Institute and Department:
Designation
Address:
Phone: / Mobile: / Email (Mandatory for Communications Purposes)
Profession:Select onePhysicianDr-in-trainingMedical studentNurseAllied Health ProfessionalIndustry Professional
Specialisation:
If you will like to be updated on any upcoming NHCS events, please check the box below. When you like to stop receiving event updates from NHCS, please email .
Yes, please send me updates on upcoming NHCS events.
REGISTRATION FEES Amount is inclusive of 7% Goods and Services Tax (GST)
On or before 19September / After 19September
Physician / SGD225.00 / SGD335.00
Drs-in-Training, Nurses and Allied Health / SGD115.00 / SGD225.00
METHOD OF PAYMENT Registration is confirmed upon full payment
By CREDIT CARD
I hereby authorise the CTO Interventions Live Course Secretariat to charge the total amount of SGD to my
AMERICAN EXPRESS MASTERCARD VISA
Cardholder’s Name (as on credit card):
Credit Card Number:Expiry Date(mm/yy):
Security number:Cardholder’s Signature:
(Last 3 digits on reverse side of Visa/Mastercard
Or4 digits on the front of the card for AMEX)
By INVOICE
Bill to (Company & Contact Person):
Mailing Address:
By CHEQUE(Only cheques from Singapore banks are accepted)
Please make cheque payable to ‘National Heart Centre of Singapore Pte Ltd’ and indicate “CTO Live Course 2014” on the reverse side. Mail to National Heart Centre Singapore,c/o Corporate Development, 168 Jalan Bukit Merah, Connection One (Tower 3) #07-08, Singapore 150168

CANCELLATION/REPLACEMENT POLICY: Request for cancellation/replacement must be made in writing to 24 October 2014. The Organising Committee regrets that requests for cancellation and refund received after this date will not be entertained. All refunds (if applicable) less 50% for administrative charges will be issued after the event. All nomination for replacement should be made in writing to by 31 October 2014.