AMIA10x10 (Gateway to Health Informatics) Online Registration Form
Distance-Learning with Live, Online Tutorials
Name of Participant: *
Title: *
Email address: *
Telephone contact: *
Please indicate *
Please indicate: *
Billing Person's Name: *
Billing Address: *
Postal Code *
Participant's Organization *
Participant's Job Designation: *
NRIC / FIN No. (last 3 digits + alphabet eg xxxx365B)
Date of Birth - dd/mm/YYYY (Required by IMDA) *
Course Fee:
- Course fee is SGD $3,000 net (No GST) for all (Singapore and non-Singapore) participants
- Singapore citizens who are self-sponsored or sponsored by approved organizations/institutions are eligible for Course fee reimbursement under IDA’s CITREP+ (Terms Apply). See Course site for details
- Singapore citizens who are self-sponsored are also eligible to use all or part of their Skills Future Credits (SFC).

Closing Date for Registration
Registration closes 1 week before Course Start Date
Any cancellation or replacement must be conveyed to the Course Administrator, Gateway Consulting, in writing. A cancellation charge of 10% of course fee will be levied if cancellation is received after Registration Closing Date and before Course Start Date. There will be no refund if the cancellation is received on or after Course Start Date. The organizer reserves the right to modify the Course program without prior notice or cancel the Course, with full refund to participants who had fully paid the Course fees, should unforeseen circumstances necessitate the cancellation of the Course.

By completing this form, you have consented and agreed to the collection, use and disclosure of your personal data for marketing, as well as administrative & business operations of Gateway Consulting Pte Ltd.
The Course Administrator,
Gateway Consulting,
#02-02 Crown Centre, 557 Bukit Timah Road,
Singapore 269694.
Tel: (65) 8012 0405 / 8121 9898
Cheque payment (preferred) should be made in favour of
“Gateway Consulting Pte Ltd”.
Accepted modes of payment – cheque / bank GIRO / money order.
For other forms of payment, please contact the Course Administrator
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