REGISTRATION FORM - 17th Annual Colposcopy Course / 18th Annual Oration and Dinner
To register, please fill in the form below, alternatively, you may
download this form here
and fax it to the secretariat at: (65) 6372 1793
Salutation *
Prof
A/Prof
Dr
Mr
Ms
First Name *
Family Name *
Gender *
Male
Female
Mailing Address
Telephone/Mobile No. *
Email Address *
Institution
SCCPS Member *
Yes
No
MCR No. *
(if applicable)
SCCPS PREINVASIVE SURGICAL WORKSHOP – 24 MARCH 2012
(Limited to the first 18 registrants)
Specialist in Practice ($150.00)
Specialist Trainees ($50.00)
18TH ANNUAL ORATION – 24 MARCH 2012
(Limited to the first 80 registrants)
17TH ANNUAL COLPOSCOPY COURSE – 25 MARCH 2012
With Oration and Dinner
SCCPS Member ($100.00)
Non-SCCPS Member ($150.00)
*I would like to attend the Oration and Dinner
Yes
No
Trainees
With Oration and Dinner ($95.00)
Without Oration and Dinner ($60.00)
17TH ANNUAL COLPOSCOPY COURSE ONLY
Nurses ($60.00)
Payment
Payment Method *
-- Select your payment method --
Cheque/Bankdraft
Credit Card