Update in Paediatric Respiratory Diseases 2019 - Registration

REGISTRATION FORM

PERSONAL INFORMATION
* Mandatory field
Please fill out the form in English
First Name : *
Middle Name :
Family Name :
Gender: *     Male     Female

JOB INFORMATION

  
Position : *
Specialty : *
Institution : *
Department : *

CONTACT INFORMATION

  
Mailing Address : *
 
Postcode :
State : *
Country : *
Tel. No. : *
Ext : *
Fax No. : *
Mobile No. : *
Email : *


REGISTRATION FEE
1-Day Workshop + 2-Day Conference
Early-bird rate (Until 31 October 2019)
Normal Onsite rate
Clinicians     HK$2,000 Clinicians     HK$2,800
Allied Health/Nurses     HK$9,00 Allied Health/Nurses     HK$1,500
2-Day Conference
Early-bird rate (Until 31 October 2019)
Normal Onsite rate
Clinicians     HK$1,200 Clinicians     HK$2,000
Allied Health/Nurses     HK$500 Allied Health/Nurses     HK$900
 
Payment Method : * Cheque (Please register, print out the acknowledgement letter and mail to us together with the cheque)
      Bank :     Cheque No. :
      payable to The Chinese University of Hong Kong

Bank Transfer (Please transfer before you register)
      Date of Transfer :   / / 2019  Transaction ID :
Bank Details :
Account Name : The Chinese University of Hong Kong
Account Number :293-005005-001
Bank :Hang Seng Bank Limited
Swift Code : HASE HKHH
Bank Address : Kowloon Main Branch, 618 Nathan Road, Kowloon, Hong Kong