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 MWIA 2017 Conference Secretariat.

MWIA 2017 Conference Secretariat
c/o International Conference Consultants Ltd. (ICC Ltd.)

Office Address: Unit C-D, 17/F, Max Share Centre, 373 King's Road, North Point, Hong Kong
Tel: (852) 2559 9973     Fax: (852) 2547 9528     Email: mwia2017@icc.com.hk


    (A) PERSONAL INFORMATION
 
(*) Compulsory fields
Title: * Others, please specify:
Last Name: *
First Name: *
Position: *
Department:
Organization/Hospital: *
Address: *
 
 
City/Region/State:    
Postcode: Country:*
Tel: *
(country code) (area code) number
Fax:
(country code) (area code) number
Email: *
  (Email is required for further communication.)
I am a member of the HKWDA.   / I am a member of the MWIA.
Dietary Requirement: Vegetarian     Allergic to Food    (Please specify: )
 
    (B) REGISTRATION FEE

Registration Category
Early-Bird Rate
(On or before 30 April 2017)
Regular Rate
(After 30 April 2017)
Non-Hong Kong Delegate - Including Gala Dinner and Hospital Visit^

HK$3,900 (US$500)

HK$4,700 (US$600)

Hong Kong Delegate - Including Gala Dinner and Hospital Visit^ HK$3,200 (US$400) HK$4,200 (US$525)
Hong Kong Delegate - Including Gala Dinner

HK$2,000 (US$250)

HK$3,000 (US$375)

Hong Kong Delegate - Conference ONLY HK$1,700 (US$215) HK$2,700 (US$340)
Hong Kong and Non-Hong Kong Nurse - Conference ONLY HK$900 (US$115)
Hong Kong and Non-Hong Kong Allied Health - Conference ONLY HK$900 (US$115)
Hong Kong and Non-Hong Kong Student* - Including Hospital Visit^ HK$800 (US$100)

Hong Kong and Non-Hong Kong Student* - Conference ONLY

HK$200 (US$25)

Additional Gala Dinner Ticket (For Nurse, Allied Health, Student or Accompanying Person)

HK$1,200 (US$150)

HK$1,600 (US$200)
Sub-total (B)
HK$

Registration fees include participation in scientific sessions, light lunch and tea breaks on 26 August 2017, a set of Meeting materials, and the function(s) specified for each registration category.  Visa application fee to Hong Kong and Mainland China are NOT included.

* Verification letter from your institution or hospital is required to qualify for “Hong Kong and Non-Hong Kong Students” rate.

^
Please indicate the Hospital Visit you would like to participate:  
(As space for each visit is limited, it will be allocated on a first-come-first-served basis.  Information will be announced in due course):
Hong Kong Hospitals Visit
Shenzhen Hospitals Visit (Prior application of Visa to Mainland China is required for non-Hong Kong delegates)
I will not join any hospital visit.


   (C) PAYMENT DECLARATION

Payment must be made in Hong Kong Dollars (HK$). Registration fee in US$ is for reference only.
I would like to settle the payment (Part B) in HK$  by:

 

Cheque (in Hong Kong dollars only) made payable to “International Conference Consultants Ltd.” (For Hong Kong Participants only)

Credit Card (in Hong Kong dollars only)
I hereby authorise International Conference Consultants Limited (ICC Ltd.) to debit the above-mentioned amount from my card.
VISA     MasterCard  
(Please contact your credit card company to notify them of this international charge to prevent the transaction from being rejected. The merchant name shown on the statement will be "ICC LTD" and the amount charged will be in HK$.)
Card No. - - -
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:

Rules and Regulations for Registration:

  1. Each registrant should complete a separate registration form.
  2. Registration form without payment will NOT be processed.  Please do NOT send cash.
  3. The MWIA 2017 Conference Secretariat will send a registration confirmation by email upon receipt of your registration form and full payment.  Kindly check the confirmation.  Any changes or alterations must be made in writing to the MWIA 2017 Conference Secretariat.
  4. Refund for cancellation of registration will be made and subject to the following deadline and administrative charge:
  5. On or before 30 April, 2017

    50% of the registration fee

    After 30 April, 2017

    No refund

  6. The programme is subject to change without prior notice.  In the event of cancellation of the Conference due to typhoon, flooding, earthquake and any other uncontrollable natural disasters, all the registration fees paid will NOT be refunded by the Organizers.
  7. All enquiries, changes and cancellations should be made in writing to the MWIA 2017 Conference Secretariat.
  8. The information on this Form is to assist us in preparing your participation in the Conference.  All the information you provide will be restricted to the Organizers of MWIA 2017 and other related working parties.  You have the right of access and correction with respect to your personal data held by us.  If you wish to exercise these rights, please contact the MWIA 2017 Conference Secretariat.

 

   (D) HOTEL ACCOMMODATION

The Conference will be held at the Hong Kong Academy of Medicine Jockey Club Building on 25-27 August 2017. The organizer has reserved certain number of guest rooms at the following hotels for the participants.

If you need other room types or group booking, please write to Conference Secretariat.

No hotel reservation required. I will arrange my own accommodation and will stay at Hotel.
Hotel Room Type Room Rate Per Room Per Night ^
(Subject to 10% service charge)
Travelling Time to Conference Venue (approximately)
Single Room
(with 1 breakfast)
Double Room
(with 2 breakfasts)
L’hotel Island South*
(4-star)
Premium Hill View Room                        HK$950                       HK$1,050 5 minutes on foot
Ovolo Southside*
(4-star)
Mini Room                       HK$980                       HK$980 10-15 minutes on foot /
5 minutes by taxi
(taxi fare - HK$30)

^The rate is subject to 10% service charge and prevailing government tax (tax is 0% as of today).
*With complimentary in-room Wi-Fi internet access.

Occupancy: * Single Double
Bed Type: * One Bed     Twin Bed
Date of check-in: Date of check-out:
No. of Nights:    
Arrival Time & Flight (ETA):   Departure Time & Flight (ETD):
I will be sharing with
Special Requests: * Smoking Room Non-Smoking Room
Other Requests,
please specify

Terms and Conditions (Hotel Reservation):

  1. The room rates will be charged in Hong Kong Dollars (HK$). Prevailing exchange rate is US$1 = HK$7.75 approximately.
  2. To enjoy the above room rates, participants should make the reservations through the Conference Secretariat, International Conference Consultants Limited (ICC LTD). Credit card details are required to secure your booking.
  3. Hotel reservations will be taken on a first-come-first-served basis and will be subject to room availability. Secretariat has the obligation to return all the unsold rooms to the hotels after 20 July 2017. Therefore room availability and listed room rates cannot be guaranteed for reservation made after that date.
  4. The above hotel rates are only valid during the conference period for participants attending our conference. All bookings for days outside the Conference period will be subject to availability.
  5. Cancellation Policy:
    L’hotel Island South
    • One-night deposit is required upon reservation. Deposit is non-refundable and non-transferable.
    • Full payment is required by credit card on 20 July 2017; otherwise, deposit will be forfeited. Without full payment, booking will not be confirmed.
    • Cancellation or change in period of stay after 20 July 2017 / No show will result in forfeiture of full payment.

    Ovolo Southside
    • One-night deposit is required upon reservation. Deposit is non-refundable and non-transferable.
    • Cancellation or change in period of stay after 20 July 2017 / No show will result in full room charges for the entire period of stay reserved.
  6. All enquiries, changes or cancellation of reservations should be addressed to Secretariat (NOT directly to the hotel). Participants have agreed to abide by the terms and conditions of hotel reservation upon submission of hotel reservation.

To Guarantee Your Reservation


I would like to use the above credit card to guarantee my hotel reservation and agree to be bound by the terms and conditions of hotel reservation.


   OR
I would like to use the following credit card to guarantee my hotel reservation and agree to be bound by the terms and conditions of hotel reservation.
        VISA      MasterCard    
  Card No. - - -
  Name of Cardholder
  Expiry Date / (MM/YY)

I hereby agree to be bound by the rules and regulations of the conference.