Conference Registration Form (R1)
 
  I. PERSONAL PARTICULARS OF DELEGATE
Fields in BOLD are required fields.
Title
 FIRST Name
 MIDDLE Name
 LAST Name
Organization / Company / Institution
Trade Association (if applicable)
Department
 Designation
Mailing Address
City
State
Zip/Postal Code
Country
Telephone Number
Country Code    Area Code
 ( ) -   		Fax Number
Country Code    Area Code
 ( ) -  
E-mail Address
 
  II. REGISTRATION FEE
Registration Fee
(per person) 		Early Registration Fee
By 31 Jan 2010
(SGD) 		Standard Registration Fee
1 Feb to 19 Feb 2010
(SGD) 		Late / Onsite Registration Fee
After 19 Feb 2010
(SGD) 		Total Amount (SGD)
Main Conference Registration
  Standard
SGD 650.00 SGD 700.00 SGD 750.00 SGD
  Associates1
SGD 590.00 SGD 630.00 SGD 680.00 SGD
  Student / Fellow2
(With student documents)
SGD 490.00 SGD 530.00 SGD 570.00 SGD
 
Full Conference Registration (Main Conference cum Pre-Conference Workshops)
  Standard
SGD 850.00 SGD 950.00 SGD 1,050.00 SGD
  Associates1
SGD 790.00 SGD 880.00 SGD 980.00 SGD
  Student / Fellow2
(With student documents)
SGD 690.00 SGD 780.00 SGD 870.00 SGD
 
Day Registration
(Please tick one option only)
  18 March 2010
19 March 2010
20 March 2010
SGD 330.00 SGD 350.00 SGD 380.00 SGD
 
Pre-conference Workshop : Day 1 (16 March 2010)
  Motivational Enhancement Therapy
Sex In The City
Understanding Cyber Addictions
SGD 200.00 SGD 250.00 SGD 300.00 SGD
 
Pre-conference Workshop : Day 2 (17 March 2010)
  Gambling Intervention
Understanding Addiction & Recovery
Attention Deficit Hyperactivity Disorder
SGD 200.00 SGD 250.00 SGD 300.00 SGD
 
  Conference Dinner
No. of persons :
SGD 80.00 SGD 80.00 SGD 80.00 SGD
 
 
(I) Total Amount in Singapore Dollars
(A) = [(I) x 5%] Bank Administrative Charge for Payment by Option I (Credit Card)
(B) Processing Fee for Payment by Option II (Singapore Cheque) Inclusive
(C) Processing Fee for Payment by Option III (Telegraphic Transfer / Bank Draft) SGD 50.00
(I) + (A) or (B) or (C) Grand Total in Singapore Dollars SGD
  For group bookings of 8 or more, please contact the Conference Secretariat.
1Please tick the appropriate selection :
WE Care Community Service            The Australasian Professional Society on Alcohol and other Drugs (APSAD)
National University of Singapore      KAAP      Promises Pte Ltd
2To submit the necessary student documents together with this registration
 
Other Personal Information: (Please check your preferences)
Food Preference Normal Halal Vegetarian
 
  III. MODE OF PAYMENT
  You are not registered until payment is received.
 Please select a payment method. 		 
  OPTION I : CREDIT CARD (CC)  
 
 
 
     
 

Cardholder's Name (as on credit card):
Credit Card Number :     Expiry Date:  
Visa/Master - 16 digits, American Express - 15 digits

Security Code :
(Note for AMEX Card: please enter the four-digit security number printed on the right corner on the front of your card)
(Note for VISA / Master Card : Please enter the three digit security code on signature panel)
I hereby authorise "APBAM or Ace:Daytons Direct (International) Pte Ltd" to debit my credit card with the total amount of: SGD + 5% administrative charge = SGD
 
 
 
Cardholder Signature (as in Credit Card):



________________________________(essential)

 Date of Authorisation (dd/mm/yyyy):



______________________________
(Authorising Charge and Acknowledging Cancellation Policy)
Should there be an error in the sum of the total above made by the registrant, "APBAM or Ace:Daytons Direct (International) Pte Ltd" reserves the right to charge the correct amount.

Before submitting this registration form, please print a copy acknowledge your authorisation of payment above and fax completed form to (65) 6475 2077
 

 
  OPTION II : LOCAL CHEQUE (LC)  
 
 
Cheque Number: Name of Bank:
AMOUNT OF PAYMENT ENCLOSED: SGD
 
 
Signature:



________________________________

   Date of Registration (dd/mm/yyyy):



______________________________
 
  OPTION III : TELEGRAPHIC TRANSFER (TT) / BANK DRAFT (BD)  
 
Draft / TT Number: Name of Bank:
AMOUNT OF PAYMENT ENCLOSED: SGD
(Note that a SGD50 bank administrative charge will be added to payments by bank drafts/ telegraphic transfers)
For payment by TT Before submitting this Registration Form, please print a copy, acknowledge your authorization of payment below and fax the completed form(s) to (65) 6475 2077.
Signature:

________________________________

   Date of Authorisation (dd/mm/yyyy):

______________________________
  IMPORTANT GUIDELINES - REGISTRATION (R2)
  • Please ensure that your registration form (R1) has been completed and duly signed and all correspondences related to registration should be properly enclosed and mailed to:

1st APBAM 2010 : Conference Secretariat
c/o Ace:Daytons Direct (International) Pte Ltd
2 Leng Kee Road, #04-01 Thye Hong Centre, Singapore 159086
Tel: +65 6379 5259 / 6379 5261 Fax: +65 6475 2077
Registration forms received without payment or credit card details will not be processed. You are not registered until full payment is received.

  • Payment Details :
    1. Option I : Payment by Credit Card
      • The 5% bank administration charge will be imposed for any transaction made via credit card.
      • Should there be an error in the grand total amount (Form R1), the 1st APBAM 2010 : Conference Secretariat reserves the right to charge the correct amount.

    2. Option II : Payment by Singapore Cheque
      For payment by Singapore Cheque, it should be made payable to "APBAM" in Singapore Dollars (SGD) only on the amount shown on the reverse page. Please indicate the registrant's name on the back of the local cheque and send it together with the completed Official Registration Form to the "1st APBAM 2010 : Conference Secretariat" at the above-listed address. Cheque will not be accepted after 26 February 2010, Friday.

    3. Option III : Payment by Telegraphic Transfer (TT) /Bank Draft (BD)
      • All Telegraphic Transfers should be made in Singapore Dollars and payable to:

        Bank Name : Standard Chartered Bank (Anchorpoint Branch)
        Bank Address : 370 Alexandra Road #01-33 Anchorpoint Singapore 159953
        Bank Account Name : APBAM
        Bank Code : 7144
        Branch Code : 013
        SWIFT Code : SCBLSGSG
        SGD Account Number : 13-100505-19

      • Please note that a processing fee of SGD 50 will need to be included for payment by Telegraphic Transfer / Bank Draft.
      • Please indicate the registrant’s name on the front of the telegraphic transfer advice after payment has been made and either email or fax the advice together with a copy of the completed Official Registration Form to the Conference Secretariat at Fax: 65-6475 2077.
      • Payments by Telegraphic Transfer need to be received by the Conference Secretariat on or before 26 February 2010, Friday.
      • Bank Draft will not be accepted after 31 January 2010, Sunday.

  • You may also fax the completed and duly-signed registration form to the 1st APBAM 2010 : Conference Secretariat at Fax: +65 6475 2077. However, if you have already registered online or faxed your registration form with a credit card payment, please do not mail a copy of this form as it may result in a duplicate registration.
  • Registration Fees
    All participants are required to pay the Full Registration Fee (in Singapore Dollars) stated in the registration form, which includes the following:
    1. Main Conference
      • Name badge, conference bag, Certificate of Attendance, programme and abstract book
      • Admission to all tracks and plenary sessions of 1st APBAM 2010 held from 18 - 20 March 2010 only
      • Invitation to Opening Ceremony and Welcome Reception
      • Full-day conference : Two tea breaks and one lunch
      • Half-day conference : one tea break only
      • Entrance to Trade Exhibition
    2. Pre-Conference Workshop
      • Name badge, Certificate of Attendance and workshop materials
      • Admission to scientific sessions during the pre-conference workshop held on either 16 or 17 March 2010 only
      • Full-day conference : Two tea breaks and one lunch
    3. Full Delegate : Refer to delegates attending both the main conference and pre-conference workshops held from 16 to 20 March 2010.
    4. Special registration fees for local delegates with approved VCF funding
      VCF TRAINING GRANT – The 1st APBAM 2010 Conference is supported under the VWOs-Charities Capability Fund (VCF) as a pre-approved course.
      1. 60% VCF Funding for Singaporeans/ and Singapore PRs staff/volunteers from VWOs who are NCSS Member)
      2. 40% VCF Funding for Singapore Work Permit / Employment Pass Holders from VWOs who NCSS Member)
    • How to apply for VCF funding
      1. Eligible staff from NCSS member VWOs can apply on-line via the VWO Corner located at www.ncssapp.org.sg before the Conference commences. Singapore Employment Pass or Work Permit holders must have at least a year of service remaining with the organization at the point of application.
      2. The applications for funding are subject to VCF approval. All approved VCF funding applicants would receive an approval email from the VCF Secretariat with a reference number (LTxxxxxxxxx / FYxxxxxxxx).
      3. Please click on www.apbam.org to register for the Conference and please submit the approval email to the 1st APBAM 2010 : Conference Secretariat by email: admin@apbam.org or by fax : 6 475 2077 before 19 February 2010.
      4. Please make cheque payable to "APBAM". The payment should reach the Conference Secretariat by 26 February 2010. 
    • Terms and conditions
      1. Eligible applicants must achieve at least 75% attendance to qualify for VCF subsidy. A medical certificate is required as verification for absence due to illness.
      2. Please sign on the Attendance Sheet at the Conference Registration Desk designated for VWO Staff/Volunteers everyday.
  • Registration Deadlines
    • Deadline for Early Bird Registration : 15 January 2010, Friday
    • Deadline for Standard Registration : 19 February 2010, Friday
  • Confirmation of Registration
    Within 5 days after the clearance of your payment, you will receive a confirmation either via email or fax only. Please include your email address and fax number clearly in the registration form.
  • Cancellations and Refunds
    Any cancellation and request for refunds must be submitted in writing to the “1st APBAM 2010 : Conference Secretariat” by 22 January 2010, Friday. Refunds, less SGD 100 administrative fee & the necessary refund administrative charges, will be made within two months after the 1st APBAM 2010. No refunds can be made for requests received after 22 January 2010, Friday

  • For on-site registration, only cash (Singapore Dollars) and credit card payments will be accepted.

  • Language : The official language of the Conference is English. There will be no translations available.

  • Group Registration
    If you are responsible for a group of more than 5 attendees, please contact the 1st APBAM 2010 : Conference Secretariat at tel: + 65 6379 5260 or email: admin@apbam.org for group registration details and instructions. For every registration of 10 or more delegates and in one single payment, you will get to register the 11th delegate FREE. All group registrations must be received by 19 February 2010, Friday.
Print before you submit
Before submitting, please print a copy of this Registration Form. Please acknowledge your authorisation of payment by filling-in the "Date of Authorisation" and signing your "Signature as in Credit Card" and fax the completed form(s) to (65) 6475 2077.

Clink here to print
Before submitting this form, it is important to read through the IMPORTANT NOTES.