Registration Form

Date: 13th November 2016 (Sunday)
Time: 8.00am – 1.00pm
Venue: Conference Room, Level 1, Regency Specialist Hospital

Please note that registration is based on a first-come-first-served basis.

Closing Date: 10th November 2016
Please fill in the registration form below to confirm your attendance. Thank you.

* 1. Name:

* 2. Sex

* 3. Identification Card Number:

* 4. Email address:

* 5. Phone number:

* 6. Please indicate your dietary preference:

* 7. Are you a diabetic patient?

* 8. How long have you been diagnosed with Diabetes?

* 9. Are you taking any diabetes medications?

* 10. Have you heard of carbohydrate counting?

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