Short Course Registration Form
Registration for Short Course - Vaccinology for Clinical and Public Health Practice [10 to 14 November 2014]
Personal Particulars
Title *
Name *
Email Address *
Mailing Address *
Please indicate which Country you are based in *
Contact Number *
Please include country code if outside of Singapore; for example 65-12345678
MCR Number
Applicable for Doctors registered with the Singapore Medical Council
NUS or LSHTM may contact you in the future with information about other activities that we think may be relevant to you. We will not give your details to any third party. *
Application Information
Closing date for registration: 1 October 2014

Applications are on “first-come-first-served” basis. Course fees must be received by the stipulated date to secure a place.

Successful applicants will be informed no later than 3 October 2014, and course fees must be received by 10 October 2014 to secure a place.
Course Fees
Singapore Dollars 1,498.00 (Singapore Dollars One Thousand Four Hundred and Ninety-Eight and Cents Zero only) per participant per course.

The fees quoted are inclusive of the prevailing GST.
Please acknowledge that the payment is due by 10 October 2014. *
Cancellation Policies
1. A cancellation charge of 50% of course fees will be levied if any cancellation notice is received before the stipulated date for the respective courses.

2. No refunds will be given for any cancellation notice received from the stipulated date for the respective courses onwards but replacement with another participant is permissible.

3. The organizer reserves the right to cancel the course and fully refund the fees in the event of unforeseen circumstances.

Any cancellation must be conveyed to the course administrator in writing via email. A cancellation charge of 50% of fee will be levied if the cancellation is received BEFORE 17 OCTOBER 2014.

NO REFUNDS WILL BE GIVEN FROM 17 OCTOBER 2014 ONWARDS but replacement with another name is permissible.
Please acknowledge that you have read and agree to the cancellation policies. *
1. Cheques/ bank drafts (drawn on a bank in Singapore in Singapore dollars) to be made payable to the ‘National University of Singapore’. All cheques have to be valid for at least 3 months upon receipt by the school.
2. Payment is possible via interbank transfers (locally or internationally). Any bank charges related to the transfers are to be borne by the payer.
3. More details on payment will be given upon confirmation.
Payment Method *
Payment Mode *
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