Contact Nuclear Medicine Update 2011

Registration

Registration Fee: SGD 300
Closing Date: 31st December 2010

To register please fill out the form below. Fields marked with a * are mandatory.

*	Title	Prof Dr. Mr. Mrs. Miss.
*	Name
*	Surname
*	Date of Birth (dd/m/yyyy)
*	Gender	Male Female
*	Designation
*	Qualification	Medical Doctor Scientist Radiographer/Technologist
*	Department
*	Institute
*	Address Line 1
	Address Line 2
*	Post Code
*	City
*	Country
*	Telephone
*	Fax
*	Email

My present job involves
a)	General Nuclear Medicine Imaging	Yes No
b)	SPECT Imaging	Yes No
c)	Nuclear Cardiology	Yes No
d)	PET / PET-CT Imaging	Yes No
e)	Radionuclide Therapy	Yes No

Payment Options
1.	Cheque / Bank Draft of SGD300 if paying by cheque please provide us with the cheque number	All cheques / bank drafts should be made payable to “Singapore General Hospital Pte Ltd”. Kindly indicate your name, contact number and that the payment is meant for “SGH Nuclear Medicine Update 2011” at the back of the cheque/bankdraft and mail to: SGH Nuclear Medicine Update 2011 Secretariat C/O Events-360 589C Montreal Drive # 07-136 Singapore 753589

2.	Telegraphic Please mention the name of the bank you have transferrred money through	Please remit SGD 300 to the following: Bank Name : DBS Bank Ltd Branch Name : Great World City Branch Bank Address : 1 Kim Seng Promenade #02-32 Singapore 2379943 Bank Code : 7171 Branch Code : 032 Account No. : 032-001600-6 Swift Code : DBSSSGSGXXX Please state that the payment is for “SGH Nuclear Medicine Update 2011, I.O No.: 51304481” and indicate your Name clearly. Upon completion of the transfer, please fax a copy of your remittance advise with your name to the secretariat at (65) 66182335 or email eesia.tan@events360.com.sg for tracking purposes. *Payment made by Telegraphic Transfer or Bank Draft should be made net of all bank charges and commissions.

Developing Countries Assistance (Approval for registration fee waiver and free accomodation will be at the discretion of the organising committee )
(a)	Wavier of Registration Fee	Yes No
(b)	Free Accommodation	Yes No
(c)	Please describe how your participation in this meeting will benefit you and your institution

Cancellation Policy
Requests for cancellation/replacement must be made in writing to the Conference Secretariat. 50% of the registration fee will be refunded for cancellation received on or before 15 February 2011 and refunds will be made after the Conference. No refund will be made for cancellation received after 15 February 2011.