Faculty Information (Information will be used for Certificate and CPE attendance submission)Title(Required)ProfA/ProfDrMrMrsMdmMsName(Required) First/Given Name Last/Surname Country(Required) AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country MCR No / SNB Reg No(Required) (For Singapore Registered Doctors and Nurses Only. Enter NA is Not applicable)Designation/Division/Department/Faculty/Institution(Required)Please provide us your Designation, Division, Department, Faculty and Institution that you want us to publish on our publication and websiteExample Head and Senior Consultant Department Hospital NameEmail(Required) Secretary or PA Email Mobile No.(Required)I will be attending:(Required) In-person Virtual Conference Registration(Required) Friday, 29 July 2022 Saturday, 30 July 2022 Select AllDietary Selection(Required) Vegetarian Normal (no-pork, no-lard) Lecture Recording and Publication ConsentIt is understood that all material will be used in a legitimate manner, for educational and marketing purposes, both internally and outside Healthcare Quality Society of Singapore, and is not intended to cause any harm or undue embarrassment to the parties involved.Lecture Abstract Your lecture abstract may be printed on programme booklet and are made available on event official website (in secured PDF format). Kindly indicate whether you allow the publication of your synopsis.Lecture Abstract You may publish my lecture synopsis in the programme booklet. You may publish my lecture synopsis on the website in secured PDF format Please DO NOT publish my lecture synopsis Presentation Slides Your presentation slides may be made available on the event official website. Kindly indicate whether you object to it being posted on the website in secured PDF format.PPT You may post my presentation Slides in PDF format Please DO NOT post my presentation slides. Some material may be posted. Please work with me directly Video & Audio Recording The meeting will be audio and video recorded and/or live broadcasted through web streaming. Kindly indicate if you object to the recording, web streaming and publishing of your lectureVideo Audio Recording I agree to the recording and live broadcasting of my lecture I agree to the publication of the audio and video recordings, either be on a publicly available website or on an access- restricted site I waive any right to inspect or approve the finished video recording I agree that all such pictures, video or audio recordings and any reproduction thereof shall remain the property of the author and that Healthcare Quality Society of Singapore may use it as it sees fit Select AllA/V Equipment NeedsAV Equipment I will be using the notebook provided I will be using my own notebook I will need A/V equipment other than computer and projector Please specify the A/V or IT Equipment you need CAPTCHA
