REGISTRATION FORM DELEGATE’S INFORMATION(Information will be used for Badge and Certificate Printing) Salutation*ProfA/ProfDrMrMrsMdmMs Name*FirstLast Designation* Profession:*DoctorNurse PharmacistOthers MCR No:* SNB Reg No:* Institution & Dept* Mailing Address* Contact Number* Email*REGISTRATION FEES(Please tick ü accordingly)CategoryEarly Bird(till 31st July 2022)Regular Rate(from 1st August 2022)HQSSMembers*SGD $1400 (Inclusive of GST)SGD $1750 (Inclusive of GST)Non-HQSS MembersSGD $1650 (Inclusive of GST)SGD $2000 (Inclusive of GST) Registration:*HQSS MembersNon-HQSS Members Registration Fee (1):SGD $1750 (Inclusive of GST) Registration Fee (2):SGD $2000 (Inclusive of GST) Mode of Payment*CHEQUE / BANK DRAFTPAYNOWBANK / TELEGRAPHIC TRANSFER INVOICECheque / Bank Draft, in Singapore Dollars, should be crossed and made payable to “Healthcare Quality Society of 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.UEN: T07SS0104GUse the UEN number above forthe transfer. Kindly email a screenshot of the transaction to secretariat@hqss.org for verification purposes.Account Name: Healthcare Quality Society of Singapore Account No: 008-901123-5Bank Name: DBSBank Address: 12 Marina Boulevard,Level 3 Marina Bay Financial Centre Tower 3, Singapore018982Bank Code: 7171Branch Code: 008SWIFT CODE: DBSSSGSGAllcharges, including, but not limited to, commission, bank and agency charges,that are incurred in the transfer is to be paid by payor. Co./Institution:* Department:* Mailing Address (invoice)* Contact Person:* Contact No:* Email (invoice)*Registration Notes1.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. 2.The organizing committee regrets that registration received after 26 July 2022 might not receive their conference collaterals.Cancellation Policy1.Request for cancellation/replacement must be made in writing to the Conference Secretariat, latest by 29 June 2022. The organising committee regrets that requests received after this date will not be entertained.2.Please take note that refunds (less 10% for administrative charges) will be issued after the event. reCAPTCHASubmitReset