IS 3T-in-3A 2016 Registration Form

Authors Need to Register and Make Payment by 30 September 2016 in order to have their papers included for presentation. There will be NO refund for registration withdrawal/cancellation. th 6 International Symposium on InfoComm & Venue: Singapore University of Technology and Design Mechatronics Technology in Address: 8 Somapah Road Singapore 487372 Bio-Medical & Healthcare Applications Symposium Website: http://www.is-3t-in- 23rd – 26th October 2016, Singapore 3a.org 1. Registrant’s Particulars (All fields are Compulsory)

Title: Dr. Prof. Mr. Ms. Job Title/Designation:

First or Given Name: Last or Family Name:

Name to appear on Badge:

Affiliation:

Tel: Fax: Email:

Address:

City: Country: Postal/Zip Code:

Dietary Requirement (Choose ONE only) None Halal Indian Vegetarian Chinese Vegetarian

By checking this box, I agree to disclose my particulars (name, affiliation, country, and email) to the sponsors of this event for them to contact me and/or receive marketing information on their products and services. 2. Registration Fees Per Person (Including Prevailing Taxes) Regular/Student Fee – Applicable for up to ONE paper registration and includes access to all sessions, proceedings, daily lunches, coffee/tea, and banquet dinner. MAIN CONFERENCE (Choose ONE only) By 30 September 2016

Regular SGD 310

Student SGD 260

Paper Title

Additional Items

ITEM Quantity Amount

Additional Banquet Dinner Ticket Number of tickets: SGD 50 per ticket

Total Amount Payable (Please pay in Singapore Dollars only. Thank you.) SGD 3. Payment Method–Choose ONE only

By Demand Draft/Cashier’s Order/Telegraphic Transfer Please indicate the symposium name “IEEE IS 3T-in-3A 2016” and Registrant’s Name behind your bank document. Amount must be nett of bank charges.

Bank Name: Oversea-Chinese Banking Corporation Limited Account No: 695-458414-001 Swift Code: OCBCSGSG Bank Code: 7339

Address: 65 Chulia Street, OCBC Centre, Singapore 049513

By Cheque (Issued by Singapore Banks Only) Cheque payable to “IEEE IS 3T-in-3A 2016”.

Please indicate the symposium name “IEEE IS 3T-in-3A 2016” and Registrant’s Name at the back of the cheque.

Mail the cheque to Institute for Infocomm Research, 1 Fusionopolis Way, #21-01 Connexis (South Tower), Singapore 138632 (Attn: Dr. Terence See)

By Cash (Singapore Dollars only)

4. Billing Instructions & Contact Details (If different from Registrant’s Particulars Above)

Name: Designation:

Address:

Email: Tel: Fax:

IS 3T-in-3A 2016 Secretariat: Dr. Tang Xinyi Email: [email protected] Phone: +65-6408 2342