REGISTRATION FORM DELEGATE’S INFORMATION (Information will be used for Badge and Certificate Printing)Salutation(Required)SelectProfA/ProfDrMrMrsMsMdmName(Required) First Last Designation Profession:(Required)SelectDoctorNursePharmacistOtherMCR No:(Required) SNB Reg No:(Required) Untitled(Required) Institution & Dept:(Required) Mailing Address:(Required) Street Address Contact Number:(Required)Email:(Required) REGISTRATION FEES (Please tick accordingly) Category Regular Rate (from 16 June 2022) For In-person Delegate Regular Rate (from 16 June 2022) For Virtual Delegate HQSSMembers* SGD $475 (Inclusive of GST) SGD $285 (Inclusive of GST) Non-HQSS Members SGD $580 (Inclusive of GST) SGD $350 (Inclusive of GST) Are you HQSS member?(Required) Yes No I will be attending as(Required) In-person Delegate Virtual Delegate Registration Fee (Inclusive of GST)(Required) Price: Registration Fee (Inclusive of GST)(Required) Price: Registration Fee (Inclusive of GST)(Required) Price: Registration Fee (Inclusive of GST)(Required) Price: Coupon Total Mode of Payment:(Required) CHEQUE / BANK DRAFT INVOICE PAYNOW BANK / TELEGRAPHIC TRANSFER Account Name: Healthcare Quality Society of Singapore Account No: 008-901123-5 Bank Name: DBS Bank Address: 12 Marina Boulevard, Level 3 Marina Bay Financial Centre Tower 3, Singapore 018982 Bank Code: 7171 Branch Code: 008 SWIFT CODE: DBSSSGSG All charges, including, but not limited to, commission, bank and agency charges, that are incurred in the transfer is to be paid by payor.Cheque / 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: T07SS0104G Use the UEN number above forthe transfer. Kindly email a screenshot of the transaction to secretariat@hqss.org for verification purposes.Co./Institution:(Required) Department:(Required) Mailing Address (invoice)(Required) Contact Person:(Required) Phone(Required)Email(Required) Registration Notes 1.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 15 July 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.CAPTCHA
