Registration form - National Heart Centre Singapore

9 May 2015, Saturday
Level 7, National Heart Centre Singapore
5 Hospital Drive Singapore 169609
ABOUT THE COURSE
The course aims to prepare doctors for any basic or
advanced medical examinations.
A selection of patients with classical clinical signs,
ideal for teaching and examination purposes. Do
learn from our faculty of experienced examiners,
many of whom have recently passed their MRCP and
are eager to share their knowledge with the
participants.
PROGRAMME
PROGRAMME DIRECTOR
Dr Lim Choon Pin, Consultant
Department of Cardiology
0830 - 0850
Registration
0850 - 0900
Welcome Address
0900 - 0930
Basic Cardiovascular Examination
0930 - 1230
Examination and Review Session 1
1230 - 1330
Lunch
1330 - 1630
Examination and Review Session 2
1630
End
Information is valid as of 20 Jan 2015. Organiser reserves the right to make changes
to the programme.
REGISTRATION (S$280 inclusive of GST)
Closing date: 17 April 2015
Name:
MCR Number:
Hospital:
Gender:
Male
 Female
Address:
Email:
Contact Number:
 I consent to National Heart Centre Singapore and its related corporations (collectively ‘SingHealth’), their agents and SingH ealth’s authorized service providers
to collecting, using, disclosing and/or processing my personal data, in order to send me marketing materials on upcoming events. When I like to stop receiving
event updates from NHCS, I will email [email protected]. I confirm and agree that my consents granted herein do not supersede or replace any other consents
which I may have previously provided to SingHealth in respect of my personal data, and are additional to any rights which Sin gHealth may have at law to collect,
use or disclose my personal data.
PAYMENT Confirmation will be sent via email upon full payment. Limited for the first 72 registrants, first come first serve basis.
Registration fee is non-refundable upon confirmation.
By Credit Card
 MASTERCARD
 VISA
 AMERICAN EXPRESS
I hereby authorise the PACES for Cardiology Course Secretariat to charge the total amount of SGD
__________ to my Card
Cardholder’s Name:
(as on credit card)
Credit Card Number:
Expiry Date:
(mm/yy)
Cardholder’s Signature:
Security Number:
(Last 3 digits on reverse side of Visa/Mastercard or 4
digits on the front of the card for AMEX)
By Cheque Cheque should be crossed and made payable to ‘National Heart Centre of Singapore Pte Ltd’. Please indicate your name, contact number
and event title on the back of the cheque and mail to: PACES for Cardiology 2015, National Heart Centre Singapore c/o Corporate Development, 168 Jalan
Bukit Merah, Connection One (Tower 3) #06-08, Singapore 150168
For registration and enquiries, please contact: National Heart Centre of Singapore Pte Ltd, Corporate Development tel 6704 2389 / 2381
fax 6278 6193 email [email protected]
address 168 Jalan Bukit Merah, Connection One (Tower 3) #06-08, Singapore 150168
By providing the information set out in this form and submitting the same to you, I confirm that I have read, understood and consent to the SingHealth Data Protection Policy, a
copy of which is available at http://www.singhealth.com.sg/pdpa. Hard copies are also available on request.