Please click , to download the registration form.

Registration Form

 Please complete this form in BLOCK letters.  Photocopy of this form is acceptable.

Title

    Prof.       Dr.       Mr.       Mrs.        Miss 

Given name

Surname

Position

Department

Institution/Organization 

Address  

Country

Tel

Fax

E-mail 

 

Registration Fee

Category

By 31st March 2008

Early Bird Rate

per participant

After 1st April 2008

Regular Rate

per participant

Conference on 4th May 2008

(one day)

 Sing$143 / US$100

 Sing$172 / US$120

Conference on 5th May 2008

(one day)

 Sing$143 / US$100

 Sing$172 / US$120

Conference on 4th – 5th May 2008

(two days)

 Sing$236 / US$165

 Sing$275 / US$192

Dietary Requirement

 Vegetarian

 

Others

Sponsor By
OWN
 ALCON
 AMO
 BAUSCH & LOMB
 CIBA VISION
 COOPER VISION
 NEUROMED
 ESSILOR SINGAPORE		 JOHNSON & JOHNSON
 OCULUS SINGAPORE
 PURIYVES SINGAPORE
 MENICON-MANDARIN
 TOPCON
 MANDARIN OPTO-MEDIC
 OCULUS ASIA LTD, HK
 CARLZEISS VISION

 

  

Payment

I hereby enclose a Sing$ crossed cheque or US$ bank draft in the amount of _________________ as the registration fee.

Signature: _______________________________________         Date: _________________________

Please send the form with a Sing$ crossed cheque or US$ bank draft, payable to "Singapore Optometric Association" to the following address by 19 April 2008. Confirmation shall be sent upon receipt of payment.

The Organising Committee (5th ACCLC)

1 Jalan Anak Bukit

#01-16B Bukit Timah Plaza

Singapore 588996

 

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