The Hong Kong Pain Society Annual Scientific Meeting 2017

30 September – 1 October 2017, Hong Kong

 

ONLINE REGISTRATION FORM

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Please use the Tab key to move to the next field. All information should be typed in upper and lower case (e.g. King's Road). Please press the "Submit" button after completion of the form. Your registration information and credit card details will be encrypted and securely forwarded to Conference Secretariat.

HKPS ASM 2017 Meeting Secretariat
c/o International Conference Consultants Ltd.
Unit C-D, 17/F, Max Share Centre, 373 King's Road, North Point, Hong Kong
Tel: (852) 2559 9973        Fax: (852) 2547 9528          E-mail: hkpsasm@icc.com.hk
Website: www.hkpainsociety.org


  (A) PERSONAL INFORMATION
(*) Compulsory fields
Title: * Others, please specify:
Last Name: *
First Name: *
Position: *
Department: *
Institution: *
Address: *
 
 
City/State:
Postcode: Country:*
Tel: * Fax:
Mobile: *
E-mail: *
  (E-mail is required for further communication.)
Enter e-mail again for verification: *
Special Meal Request: * None Vegetarian Pork-free Beef-free Allergic to Food, please specify:
Specialty: Others, please specify:
 
  (B) REGISTRATION FEE

Registration Category
HKPS Member*
Non-member / Overseas Delegate
Early Bird
(on/before 18 August 2017)
Regular
(after
18 August 2017)
Early Bird
(on/before 18 August 2017)
Regular
(after 18 August 2017)
1-Day Meeting (30 September)
HK$400
 HK$600
 HK$800
HK$1,000
Half-day Workshop (1 October)
Workshop A – Psychological Approach
 HK$800
HK$1,000
Workshop B – Physiotherapy and Pain Nurse Approach
HK$800
HK$1,000
 
   
Total (B)
  HK$
*HKPS Member = Current member of Hong Kong Pain Society (Paid-up member for the year of 2017)

Please indicate your attendance to the following function    Lunch on 30 September

For Overseas Delegates:  please send me hotel information.


  (C) PAYMENT DECLARATION


I hereby agree to be bound by the rules and regulations of the Meeting and settle the registration fee of HK$ by
  

Cheque (in Hong Kong dollars only) payable to “International Conference Consultants Limited” and mail it to Meeting Secretariat.  (For Hong Kong Delegates ONLY)

   
Credit Card (in Hong Kong dollars only)
I hereby authorize International Conference Consultants Limited (ICC Ltd.) to debit the above-mentioned amount from my card.
VISA     MasterCard  

(For Overseas Delegates: Please contact your credit card company to notify them of this overseas payment to prevent the transaction from being rejected.  The merchant name shown on your card statement will be “ICC LTD” and the amount charged will be in HK$.)

Card Number - - -
Name of Cardholder
Expiry Date / (MM/YY)  
If you are not using personal credit card to pay, please fill in the following details of the cardholder.
Contact Email:      Contact Phone Number:
 
  (D) RULES AND REGULATIONS
  1. Registration form without payment will NOT be processed.  Please do NOT send cash.
  2. Secretariat will send a letter of confirmation by email upon receipt of your registration form and full payment.  Any changes or alterations must be made in writing to the Secretariat.
  3. Refund for cancellation of registration will be made and subject to the following deadline and administration charge.
    All cancellations must be made in writing to the Secretariat and the refund will be made after the
    Meeting.
  4. On/before 31 July 2017

    50% of the registration fee

    After 31 July 2017

    No Refund

  5. The Programme is subject to change without prior notice.  In the event of cancellation of the Meeting, the only liability of the Organizers is to refund all the fees paid.
  6. All enquiries, changes and cancellation should be made in writing to the Secretariat.

 I hereby agree to be bound by the rules and regulations of the HKPS ASM 2017.