International Conference on “Simulations, Simulated and Standardized Patients in Health Professionals’ Education” 21st and 22nd November 2014, at University of Health Sciences (UHS) Lahore, Pakistan (Pre-conference Workshops on the 20th of November 2014) Registration Form Part-I: Bio-data Name Name to be printed on certificate Designation / Job Title Country Institution Faculty/School/Centre Department/Hospital Address City/State Zip/Postal Code Landline Cell Fax Email Alternative Email Part-II: Registration Charges Category Registration fee Before 14th November, 2014 After 14th November, 2014 Please check the relevant box PKR US$ PKR US$ Conference days 21st and 22nd November, 2014 National Faculty/Staff w International w Postgraduate students w 500 1000 Undergraduate students w 100 100 500 1000 100 150 Pre-conference Workshop – 20th November 2014 Time 09:00 am to 12:00 noon 02:00 pm to 05:00 pm Workshop Title Involving real patients in health profession’s teaching and research Facilitator Dr. Vikram Jha Dr. Gohar Wajid & Dr. Idrees Anwer Establishing simulation center in a medical college: experience from Rawalpindi medical college ‘The Good, The Bad & The Ugly’: Assessment of Attitudes and Ethics in Health Professionals Will be provided soon Will be provided soon Using simulated patients for learning and assessment of clinical skills Workplace-based assessment Will be provided soon Dr. Mowaddat H. Rana Dr. Usman Mahboob Dr. Kay Mohanna Dr. Amina Ahmed Dr. Gominda Ponnamperuma Dr. Syed Hassan Shoaib Note: That only one workshop from the morning and one from the evening slot can be booked. National Faculty / Staff w 1000 per workshop Undergraduate students w 500 per workshop International w US$ 250 per workshop Gala Dinner – 21st November 2014 at 08:00 pm National Faculty and Staff w International National Accompanying Person International Accompanying Person Dietary Preference for Conference Dinner Total Amount w w 1500 US $ 50 1000 w w US $ 40 w Vegetarian w Non-Vegetarian Part-III: Mode of Payment (Seats are confirmed upon receipt of Payment) Registration is on a first-come first-served basis upon receipt of full payment. Please make your Bank Draft payable to Treasurer, University of Health Sciences Lahore-Pakistan and on the reverse side of Bank Draft, please indicate “Simulations 2014”. Mail your Bank Draft at the given address: Office of the Pro-Vice Chancellor University of Health Sciences (UHS) Khayaban-e-Jamia Punjab, University Road, Lahore - 54600, Pakistan. Tel: 042-99237109 Cancellation Policy Any cancellation or replacement must be conveyed to the organizers in writing. Cancellation charges of 50% fee will be levied if the cancellation is received on or before 14th November, 2014. There will be no fee refund if the cancellation is received after 14th November, 2014. Part-IV: Acknowledgment Please send us an email/Fax to confirm your registration and detail of posted bank draft. Confirmation on your registration will be sent to you when we will receive your full payment. An official receipt will be sent to you within 10 working days upon receipt of payment. For any query regarding you registration, please contact at the following address: Conference Secretariat: Office of the Pro-Vice Chancellor University of Health Sciences, Khayaban-e-Jamia Punjab, Lahore – 54600 – Pakistan Phone No.+92 42 99231305-09, Fax No.: +92 42 99230870 E-mail: simulations2014@uhs.edu.pk Website: www.uhs.edu.pk Part-V: Accommodation Subsidized accommodation is available for conference attendees at the following hotels : Hotel Hotel View Garden Shadman Chowk Lahore Motel Residence 10-A Block-D New Muslim Town Lahore Silver Star Hotel 6-B-II Block H Near SherPao Bridge Lahore Hotel Royal Yorke 109, J-Block Johar Town Lahore Regency Hotel Near Sherpau bridge Gulberg Lahore Corporate Inn Residency 111-J Block Model Town Lahore Ambassador Hotel 7 Davis Road, Shimla Hill, Lahore Ph: 42-36316820 Fax: 42-36301868 Shalimar Tower Hotel 24 Main Gulberg Jail Road Lahore Sun fort Hotel 72-D/1, Liberty Commercial Zone, GulbergIII, Lahore, Pakistan. Ph: 042-576 3810 - 19 Fax: 042-575 4277 Hospitality Inn Hotel 25-26 Egerton Road, Lahore. Rate Single Double 2000 + Tax 2500 + Tax 2000 + Tax 2500 + Tax 2500 + Tax 3000 + Tax 3000 3500 3500 + Tax 4500 + Tax 3500 + Tax 4000 + Tax 4000 4500 4000 + Tax 5000 + Tax 5500 6500 6500 8500 9300 + Tax 11300 + Tax Pearl Continental Shahrah-e-Quaid-e-Azam P.O.Box#983,Lahore Ph: (42) 3636-0210, 111-505-505 Fax:+92(42) 3636-2760, 3636-4362 The above rates are valid (subject to availability) until 22nd November, 2014. After this cutoff date, it is at the hotels discretion whether to accept additional reservations, which will be subject to prevailing rates and availability. Looking forward to welcoming you in Lahore, Pakistan and wishing you a safe travel.