MICROSURGERY and FLAP DISSECTION COURSE : 17 - 22 November 2008, Singapore

Registration Deadline: 1 October 2008

Secretariat
...........................................
Department of Experimental Surgery
Singapore General Hospital
Blk 9 Level 3 Outram Road, Singapore 169308
Tel: (65) 6326 5473
Fax: (65) 6224 5229
Email: secretariat@microflap2008.com
Contact Person: Ms Inria Then

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

* Required Fields

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)

Specialty *

ENT	General Surgery	Hand Surgery	Orthopaedic
Plastic Surgery	Urology	Others

COURSE FEE (in singapore dollars) *

Select	Category	Course Fee
	Basic Microsurgery Course (max 30 participants) FULLY SUBSCRIBED	SGD850
	Flap Dissection Course (max 60 participants)	SGD1,200
	Flap Dissection Course: Lecture & Workshop Observer	SGD600

PAYMENT *

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:	Singapore General Hospital
Bank Account No.	032-001600-6
Bank Name:	DBS Bank Ltd Great World City Branch, 1 Kim Seng Road, #02-02 Singapore 237994 Bank Code: 7171 Branch Code: 032 Swiftcode: DBSSSGSGXXX
Please Quote:	IO no: 51302641

for cheque

Please make cheque payable to "Orient Explorer (S) Pte Ltd"

CANCELLATION / REFUND NOTE

Any cancellation or replacement must be covered to the Organiser in writing. A cancellation fee of 50% registration fee will be charged if the cancellation is received after 3 October 2008.

Professor Jeong-Tae Kim
Dept of Plastic and Reconstructive Surgery
Hangyang University Hospital
Seoul, Korea