Referral Form

East Asia Medical Travel will be happy to process your travel to Singapore and around the region. With our excellent travel related infrastructure in place, we will be able to offer you Personalised Travel Packages to Singapore and around the region at competitive rates! Thank you.

Your Name :                   Salutation:     

Nationality:                            Passport Number:     

Address:                   

Telephone Contact-Office:       -Home:          -Mobile:       

E-mail Address:                     

When do you plan to travel:                  How many nights do you plan to stay:          

How many adults in your party:      How many children in your party (include age):     

Type of Accommodation would you like:         Type of Room would you prefer:        

Please let us know your sightseeing tour requirement for this trip :