For Official Use
Singapore LIVE 2009 Secretariat
c/o National Heart Centre of Singapore
226 Outram Road, Blk A, #06-01 Singapore 169039
Tel
: (65) 62367417 / 41 / 20
Fax
: (65) 62210944
Enquiries : registration@singlivecourse.com
Website
: www.singlivecourse.com
Ref ID No
:
Receipt No
:
Processed by
:
Date
:
CONGRESS REGISTRATION FORM
I) REGISTRATION FEES
IMPT: Please refer to opposite page for pass access entitlements before registration
ON or BEFORE 30 JAN 2009
Physician
Others*
ON or AFTER 31 JAN 2009
Physician
Others*
PREMIER PASS
A
26 Feb – 1 Mar 09, Thurs – Sun
Allows access to Main Session, Concurrent Session between 27 Feb – 1 Mar 09, 1
Special Session on 26 Feb 09, 1 Special Session on 1 Mar 09. Excludes Hands-on
Workshops
Please tick the special session you are attending
SGD1050
SGD650
SGD1115
SGD700
SGD850
SGD450
SGD935
SGD500
SGD400
SGD250
SGD450
SGD300
STANDARD PASS
B
3-Day Pass (27 Feb – 1 Mar 09, Fri – Sun)
Access to ALL sessions except Special Session and Hands-on Workshop
C
Peripheral Vascular Intervention Programme Pass
(27 – 28 Feb 09, Fri – Sat)
Access to Peripheral Vascular Intervention Programme Only
D
Day 2 Pass (28 Feb 09, Sat) Main and Concurrent Sessions only
SGD425
SGD300
SGD475
SGD350
E
Day 3 Pass (1 Mar 09, Sun) Main and Concurrent Sessions only
SGD225
SGD175
SGD275
SGD225
SPECIAL SESSIONS
F
CANCELLED
Cardiology Symposium - MOH-Cleveland
Clinic Update (26 Feb 09, Thurs)
G
Fellows Course (26 Feb 09, Thurs)
H
Vascular Ultrasonography Workshop (1 Mar 09, Sun)
SGD400
SGD75
HANDS-ON WORKSHOPS (Limited seats available)
I
Cardiac CT Hands-on Workstation Training Workshop (1 Mar 09, Sun)
J
Free. Registration required. Seat on first-come-first-serve basis
Echocardiography Hands-on Workstation Training Workshop
(28 Feb 09, Sat & 1 Mar 09, Sun)
All fees are inclusive of government taxes. Hotel and travel expenses are not included.
* - Doctors in-training (with proof from Institution)
- Allied Health Professional (Technologist, Research Specialist, Nurse, Paramedic)
- Healthcare Industry Partners (without exhibition booth at SingLIVE 2009)
SGD250
SGD55
SGD450
SGD75
SGD300
SGD450
SGD300
SGD350
SGD300
SGD55
TOTAL:
II) REGISTRATION AND BADGE INFORMATION
Salutation
Prof
A/P
Dr
Mr
Mrs
Mdm
Ms
Name as on
Certificate
Letter of invitation required (For international delegates only)
Contact
(Cap Surname)
Tel: (
)
Fax: (
)
Institution
Institution’s
Address
Email
(Mandatory for
confirmation
letter)
III) SPECIALTY (Please tick )
Cardiac Surgeon
Cardiac Technologist
Clinical Cardiologist
Echocardiologist
Electrophysiologist
Healthcare Industry
Professional
Interventional Cardiologist
Interventional Radiologist
Radiographer
Registered Nurse
Vascular Surgeon
Others (Pls specify):
__
CANCELLATION POLICY:

Request for cancellation must be made in writing to
Singapore LIVE 2009 Secretariat, latest by 5 February
2009.
The Organising Committee regrets that cancellation requests
received after 5 February 2009 will not be entertained.

Please take note that refunds (less 25% for administrative
charges) will be issued after Singapore LIVE 2009. There
will be no refund for cancellation made after 5 February
2009.
PRE-REGISTRATION DEADLINE

Pre-registration closes on 12 February 2009. Submissions
received thereafter will be considered as on-site
registration
IV) SPONSORSHIP DETAILS
Sponsoring company, if applicable:
_
V ) METHOD OF PAYMENT
By CREDIT CARD
I authorized the Congress Secretariat to charge the total amount of SGD$
to my
American Express
Master Card
VISA
Cardholder’s Name:
_
______________________
(name as stated on credit card)
Credit Card Number:
/
/
/
Card Validation Code (Compulsory):
Cardholder’s Signature:
Expiry Date:
(3 digit no at back of Card)
By CHEQUE / BANK DRAFT: - Cheque number:
_____
Made payable to National Heart Centre of Singapore Pte Ltd
(Reverse side of cheque: To state Delegate’s Name & Course)
Mail to address stated above, attn to SingLIVE 2009 Registration Desk
By INVOICE:
Bill To
Address:
_
______________
____________
/
(mm / yy)
Registration and Course items entitlement
Please refer to the below table for access entitlements and course items applicable for each type of pass
Document Bag

Programme Book

Congress Bag

Gala Night
Special Sessions

Industry Symposia
Concurrent Sessions

Course Items
Hands-On Workshop
Main Sessions
Access
PREMIER PASS
A. Premier Pass (26 Feb – 1 Mar 09, Thurs –
Sun)








STANDARD PASS
B. 3-Day Pass (27 Feb – 1 Mar 2009, Fri –
Sun)

(Peripheral
Vascular
Intervention
Sessions only)
C. Peripheral Vascular Intervention Programme
Pass (27 – 28 Feb 2009, Fri – Sat)
D. Day 2 Pass (28 Feb 2009, Sat)

E. Day 3 Pass (1 Mar 09, Sun)


















SPECIAL SESSIONS
F. Cardiology Symposium - MOH-Cleveland
Clinic Update (26 Feb 2009, Thurs) CANCELLED

Cardiology
Symposium only

G. Fellows Course (26 Feb 2009, Thurs)
Fellows Course
only
H. Vascular Ultrasonography workshop
(1 Mar 09, Sun)
Vascular
Ultrasonography
Workshop only

HANDS-ON WORKSHOPS

I. Cardiac CT Hands-on Workstation Training
Workshop (1 Mar 09, Sun)
Cardiac CT &
Multimodality
Imaging
Symposium only
J. Echocardiography Hands-on Workstation
Training Workshop (28 Feb 09, Sat & 1 Mar
09, Sun)
Cardiac CT &
Multimodality
Imaging
Symposium only


Cardiac CT Handson Workshop only

Echocardiography
Hands-on Workshop
only
NOTE: Congress Bag and Document Bag are separate bags with different contents.