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 REGISTRATION DETAILS (please use block letters)

Name *
NRIC *
Mailing address *
 
 
Postal Code *
Country *
Occupation * Doctor   Nurse / Student / Paramedics   
  Other
Place of work *
Telephone no. *  (Home / Workplace)   (Mobile)
Fax no. *
Email address *
MCR No  (if applicable)
 FEES PAYABLE in Singapore dollars (please check one)

Membership
SEMS member/ENC member
Non-Member
No. of days 1st Day only 2nd Day only Both 1st & 2nd Day
Effective Team-work & Decision-making in Crisis Resource Management $300

Ultrasound-enhanced Emergency & Critical Management Cycle is full and closed for registration

*Please note Early Bird Discount has ended
 TOTAL AMOUNT PAYABLE (REGISTRATION AND WORKSHOPS)

   S$   



The Society for Emergency Medicine in Singapore
Refunds will be given at the discretion of the Management Committee. If you have registered and are unable to attend, full refund can be obtained 4 weeks before event start date (before 30 Jan 2009) ; 50% refund if you inform us 2 weeks before event start date (before 13 Feb 2009). No refund will be entertained within 2 weeks of event start date.

Please contact our secretary Dr Juliana Poh for assistance.
Email:     Office no.: 63213558
Postal address: Department of Emergency Medicine, Block 1 Basement 1, Office B, Singapore General Hospital, Outram Road, Singapore 169608