Online Registration

You can automatically register yourself for the upcoming symposium by filling out and submitting this form. More information on the packages can be found in the preceding page. This information will be kept strictly confidential in a registration database that is accessible only to the webmaster, as well as the reception committee.

For more inquiries, please address them to:

    Miss Chan Sze Ling

    Mr Vijayaprakash s/o Suppiah

Liaison Officers, 1st IPSF APSS Reception Committee

 

Particulars of Participant:

Name
Title
University
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Person to contact in case of emergency:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail
Relationship to
participant

Package Choice:

Package 1 S$190 (US$110) (Includes island tour)
Package 2 S$150 (US$90) (Excludes island tour)

I enclose a Bank Draft/Money Order (payable to NUS Pharmaceutical Society) of:

Full payment of S$190 for Package 1
Full payment of S$150 for Package 2

Bank Draft/Money Order number:   

Any special meal preference? If yes, please state:   

Any allergies of medical conditions? If yes, please state:   

Note: Forms without payment will not be processed.
          Payment should be made in Singapore dollars.

Please send payment to the following address:    1st IPSF - APSS
                                                                              NUS Pharmaceutical Society
                                                                              Department of Pharmacy
                                                                              Faculty of Science
                                                                              National University of Singapore
                                                                              10 Kent Ridge Crescent
                                                                              Singapore 119260

together with a passport size photo of yourself, for identification purposes.

Webmaster: Althea Lau
Copyright © 2000 [1st IPSF APSS Reception Committee]. All rights reserved.
Revised: June 05, 2000
Hosted by www.Geocities.ws

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