MEDICAL DEVICES BETC SYMPOSIUM 2013
Date: 11 & 12 January 2013 (Friday & Saturday)
Contact person: Denise Tan
Time: 8am – 6pm
Tel : 62231264 Email :
[email protected] Fax : 62247827 Address: Singapore Medical Association 2 College Road Level 2 Alumni Medical Centre Singapore 169850
Venue: Matrix Auditorium (Level 2) 30 Biopolis Street, Singapore 138671 Registration fees: $250 (inclusive of 7% GST)
• Specially for SMA / SDA members CME & CPE points pending
I would like to sign up for the BETC SYMPOSIUM 2013 – Engineering in Medical Devices on 11 – 12 January 2013. Name: Prof/ AProf/ Dr ___________________________________MCR No: ___________________ Handphone: ____________________________ Office Tel: _______________________________ Email: __________________________________________________________________________ Mailing address: __________________________________________________________________
General Practitioner
Specialist, specialty: _______________________________________
SMA Member
Non-SMA Member
SDA Member
Non-SDA Member
Payment Mode Total Cost: S$250.00 A) By Credit Card (VISA / MasterCard only). Credit Card Name: _________________________________
Option:
Visa MasterCard
--- Security Code (on reverse of Card): Card Expiry Date: / (month/year) Credit Card No.:
Signature: __________________________________
Date: __________________
B) By Cheque: payable to “Singapore Medical Association” Please mail form and cheque to: Singapore Medical Association (Denise Tan) 2 College Road Level 2, Alumni Medical Centre Singapore 169850 Registration is not confirmed until payment is received.
