1. Healthcare

APPSA: Sleep without Borders 2015
Registration Form for International Delegates
For Korean Paediatric Association (KPA) members, please register through Prof. Ahn of the Korean Paediatric Association.
Non-KPA member/
Foreign delegate (SGD)
Symposium Registration Fee
Registration Fee (until 19 Mar 2015)
SGD 60
On-site registration
SGD 80
Particulars:
Title*:
Dr
Mr
Mrs
Given name*:
Ms
Other
Family name*:
Organisation*:
Designation*:
Mailing address*:
Postal code*:
Country*:
Telephone*:
Mobile*:
Fax*:
E-mail*:
*indicates mandatory field
Payment
Enclosed is my total payment of SGD___________________ to be made through:
Cheque (Payable to “Ping Healthcare Pte Ltd”)
Please complete this form and mail together with the cheque to:
Ping Healthcare Pte Ltd
20 Sin Ming Lane #06-55 Midview City Singapore 573968
Tel: +65 6778 5620
Fax: +65 6778 1372
Email: [email protected]
Credit card – Visa/Mastercard (please delete accordingly)
Card No.: Expiry date: Cardholder’s name:
3-digit security code: Signature:
Please send the completed registration form with your payment details to:
APPSA secretariat
Ping Healthcare Pte Ltd
No. 20 Sin Ming Lane, Midview City #06-55 Singapore 573968.
Tel: (+65) 6778 5620
Fax: (+65) 6778 1372
Email: [email protected]
Payment Methods
Payment must be made in Singapore Dollars (SGD) and the following payments methods are accepted
(NOTE: All bank charges will be borne by the applicant):
(1) Online Payment by Credit Card Only VISA and MasterCard are accepted. In the event of a calculation error, the Secretariat
reserves the right to amend the total owing.
(2) Payment by Bank Draft/Local Cheque Each bank draft/local cheque must be indicated with the delegate’s name and
contact number to accelerate the registration process and to ensure payment is allocated to the correct registration. Bank
draft/local cheque must be crossed and made payable Ping Healthcare Pte Ltd
(3) Payment by Bank Transfer
Account Name : Ping Healthcare Pte Ltd
Account Number : 01-0-206641-8 (SGD a/c)
Bank Name : Standard Chartered Bank (Singapore) Ltd
Bank Address : 4 Battery Road Singapore 049909
Bank Swift Code: SCBLSG22
(4) Onsite Payment
For on-site registration, only payment via cash in Singapore Dollars (SGD), credit card (VISA and MasterCard only) and
cheque are accepted.
All outstanding payments will also be collected on-site. A copy of the bank transfer (or other proof of payment) will be
required in the event that registration fees were not credited to the secretariat account on time.
(5) Confirmation of Registration
Confirmation of registration will only be issued to registrant upon receipt of completed Registration Form and full fee
payment. Please bring identification and the email registration confirmation for validation purposes.
(6) Cancellation, Substitution and Refund Policy
Notification of cancellation must be submitted in writing to the Secretariat. No substitution and refund will be allowed.
(7) Liability and Disclaimer
Whilst every attempt will be made to ensure that all aspects of the Workshop mentioned herein will take place as scheduled,
the Forum organisers reserves the prerogative to make final changes should the need arises. The applicant acknowledges that
he/she has no right to lodge complaints against the organisers should the holding of Workshop be hindered or prevented by
unexpected political or economic events or by force majeure, nonappearance of speakers or other reasons which necessitate
program changes. With registration, the applicant accepts this provision.
(8) Insurance
Every applicant is advised to take out his/her own travel insurance and extend his/her policy to cover personal possessions
as the Workshop does not cover individuals against cancellation of bookings, theft or damage to their belongings.
(9) Use of Images
Every applicant is advised to take up his/her own travel insurance and extend his/her policy to cover personal possessions
as the Workshop does not cover individuals against cancellation of bookings, theft or damage to their belongings.