Date
11-12 Sep 2004

Venue
Stamford Ballroom Level 4
Raffles City Convention Centre
2 Stamford Road
Singapore 178882

Contact
Conference Secretariat
Biennial Scientific Meeting of The Pain Association of Singapore
c/o Corporate Development Dept
National Neuroscience Institute
11 Jalan Tan Tock Seng
Singapore 308433

Tel: (65) 6357-7617
Fax: (65) 6256-4755
Email: nni_secretariat@ttsh.com.sg

Major Sponsor:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 REGISTRATION FORM
Name:* Family: Given:
Mailing Address:*
Country*
Designation/Dept:
Institution:
Email:
Tel:* (Office) (Residence)
Fax:

Please tick accordingly

I wish to submit an abstract for poster presentation. (Pls refer to instructions for abstract submission).
Registration

Early Bird
(on or before 15 Jul '04)
Normal Fees
(after 15 Jul '04)
Please tick, fees will be calculated according to date of registration.
Members
Medical
S$125
S$150
Nurses & Paramedical
S$75
S$100
Non-Members
Medical
S$175
S$200
Nurses & Paramedical
S$125
S$150

I wish to attend the following workshop(s). Please tick accordingly.

Workshop 1

S$150.00 (members)

 S$200.00 (non-members)
Workshop 2 S$25.00
Workshop 3

S$25.00

 

I am making payment by:
*Please note that registration will only be confirmed upon payment received.
I will send in the Bank Draft/Cheque by post.
Bank Draft in Singapore Dollars or Singapore Cheque.
Bank Draft/Cheque no
Bank
Payable to "Pain Association of Singapore"

I will make payment using credit card.
Credit card (Please print out and fax the payment form on the next page)
 

Please check your details carefully before you click on submit below to file your registration.

 
Organised by:
Co-organised by: