NUS Leadership in Academic Medicine (NLAM) Programme

Flow Cytometry Workshop Hands-on Workshop for Clinician Researchers 1 – 2 November 2010 (Monday - Tuesday) Clinical Research Centre, Yong Loo Lin School of Medicine, NUS REGISTRATION FORM (Limited to 20 places only) Title: Choose from list Surname: Name: Designation: Department: Institution: Address: Contact No.: Mobile/Pager No.: Fax No.: **Email: MCR No.: **Please enter a valid email address. Confirmation of registration will be sent to your email account. Registration Fees (Please tick the appropriate box) Participants Fees NUS Full-time Clinicians S$500 (S$535, incl. of 7% GST) (Sponsorship available from CSU) NUHS Staff S$500 (S$535, incl. of 7% GST)

Others S$500 (S$535, incl. of 7% GST)

CSU will be sponsoring the attendance for full-time NUS Clinicians. Registration is on a first-come, first-served basis. NMRC will be subsidizing S$300.00 (S$321, incl. of 7% GST) for clinicians who are Singaporean or Singapore PR and are interested to apply for NMRC grants. Please provide your identity card number for verification. *Current NMRC award holders for CSA and STaR will not be eligible for the subsidy. 1) CSU Sponsorship 2) NMRC Subsidy

Staff ID no..: I/C No.: (for full-time NUS clinicians) (for NMRC subsidy)

Signature: Date: Please make cheque payable to “National University of Singapore”, write on the reverse – CSU Flow Cytometry Workshop and together with the original registration form, mail it to the address stated below. Closing Date: 22 October 2010, Friday. Registration is on a first-come, first-served basis with full payment.

For enquiries, please contact The Secretariat, Clinician Scientist Unit (CSU), NUHS Leadership in Academic Medicine (NLAM) Program Dean’s Office, Yong Loo Lin School of Medicine, National University of Singapore 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore 119228 Attn: Ms Cindy Chen, Tel: (65) 6772 3819, Fax: (65) 6778 5743, Email: [email protected]

Cancellation Clause: Any cancellation or replacement must be conveyed to the Organiser in writing. A cancellation charge of 50% of fee will be levied if the cancellation is received on or before 22 October 2010. There will be no refund if the cancellation is received after 22 October 2010. The Organiser reserves the right to cancel the workshop and fully refund the participants should unforeseen circumstances necessitate it.