4th NUH-NUS OTOLARYNGOLOGY HEAD & NECK SURGERY CONFERENCE

Logistics
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Orient Explorer (S) Pte Ltd
12 Aljunied Road
SCN Centre, #05-02, Singapore 389801
Tel: (65) 6339 8687
Fax: (65) 6339 9536
Email: secretariat@otology2008nuhs.com
Contact: Ms Marianne Yee

Registration Form
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You may download this registration form as a PDF here.

Personal Details

Title *

First Name *

Last Name *

Organisation *

Address

City *

Country *

Postal Code

Telephone

Fax

Email *

Preferred Name on Badge *

MCR Number * (for local doctors only)

REGISTRATION FEE (Singapore Dollars)
For main conference & all workshops
(excluding Temporal Bone Workshop)

Select	Description	before and on 5 September 2008	6 September 2008
	Doctors	SGD650	SGD750
	Allied Health	SGD500	SGD600
	Residents / Students	SGD450	SGD550
	Day Registration	SGD300	SGD350
	If you have selected "Day Registration" please select the days to attend: 3/10 4/10 5/10

Registration for workshops only
Select	Description	before and on 5 September 2008	6 September 2008
	Vestibular Workshop	SGD400	SGD500
	AVT Workshop	SGD400	SGD500
	Audiology Workshop	SGD300	SGD400

DELEGATE REGISTRATION INFORMATION

Full delegate registration fee includes admission to all scientific symposium sessions, Conference documentation, coffee/tea breaks (where applicable), lunch.
Conference registration fee does notinclude the pre-conference workshop.
Day delegate registration fee is for participants who attend the conference sessions for that particular day. All social activities are NOT included.

REGISTRATION FEE FOR PRE-CONFERENCE WORKSHOP (2 October 2008)

	Pre-Conference Workshop - 2 October 2008 * Hands-on Temporal Bone Dissection and Lectures (limited to 15 participants) Lecutres/Live Surgery/Demonstration on Temporal Bone with Hands-on Temporal Bone Dissection	SGD800
* Registration for Main Conference is required.

PAYMENT (in Singapore dollars)

Pay Mode

for credit card:

Card

Card No.

Name on Card

Expiry Date

for telegraphic transfer

All bank charges will be borne be the delegate. In the event of shortfall of payment received, the secretariat will collect the balance payment.

Bank details as follows:

Name of Account:	National University Hospital (S) Pte Ltd
Bank Account No.	0-820551-036
Bank Name:	Citibank N.A 300 Tampines Avenue 5 #06-00 Tampines Junction Singapore 529653
Branch No.:	760
Swift Code:	CITISGSG

for cheque

Please make cheque payable to "National University Hospital (S) Pte Ltd"