<p> IS 3T-in-3A 2016 Registration Form</p><p>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)</p><p>Title: Dr. Prof. Mr. Ms. Job Title/Designation: </p><p>First or Given Name: Last or Family Name: </p><p>Name to appear on Badge: </p><p>Affiliation: </p><p>Tel: Fax: Email: </p><p>Address: </p><p>City: Country: Postal/Zip Code: </p><p>Dietary Requirement (Choose ONE only) None Halal Indian Vegetarian Chinese Vegetarian</p><p>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</p><p>Regular SGD 310</p><p>Student SGD 260</p><p>Paper Title </p><p>Additional Items</p><p>ITEM Quantity Amount</p><p>Additional Banquet Dinner Ticket Number of tickets: SGD 50 per ticket</p><p>Total Amount Payable (Please pay in Singapore Dollars only. Thank you.) SGD 3. Payment Method–Choose ONE only</p><p>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.</p><p>Bank Name: Oversea-Chinese Banking Corporation Limited Account No: 695-458414-001 Swift Code: OCBCSGSG Bank Code: 7339</p><p>Address: 65 Chulia Street, OCBC Centre, Singapore 049513</p><p>By Cheque (Issued by Singapore Banks Only) Cheque payable to “IEEE IS 3T-in-3A 2016”.</p><p>Please indicate the symposium name “IEEE IS 3T-in-3A 2016” and Registrant’s Name at the back of the cheque.</p><p>Mail the cheque to Institute for Infocomm Research, 1 Fusionopolis Way, #21-01 Connexis (South Tower), Singapore 138632 (Attn: Dr. Terence See)</p><p>By Cash (Singapore Dollars only)</p><p>4. Billing Instructions & Contact Details (If different from Registrant’s Particulars Above)</p><p>Name: Designation: </p><p>Address: </p><p>Email: Tel: Fax: </p><p>IS 3T-in-3A 2016 Secretariat: Dr. Tang Xinyi Email: [email protected] Phone: +65-6408 2342</p>