ONLINE REGISTRATION FORM

(Healthcare Professionals)

SECURE SITE
This site uses SSL security and 128 bit data encryption.

FORM NAVIGATION
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 HKPDF 2017 Symposium Secretariat.

HKPDF 2017 Symposium Secretariat, International Conference Consultants 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: hkpdf2017@icc.com.hk


    (A) PERSONAL INFORMATION
 
(*) Compulsory fields
Title: * Others, please specify:
Last Name: *
First Name: *
Position: *
Department: *
Institution: *
Address: *
 
 
City/State:    
Postcode: Country:*
Tel: *
(country code) (area code) number
Fax:
(country code) (area code) number
Mobile: *
Email: *
  (Email is required for further communication.)
 
    (B) REGISTRATION FEE

Category
Early-bird Registration
(on or before 31/10/2017)
Regular Registration
(after 31/10/2017)
1.5 Days Symposium – Health Care Professional^

HK$ 300

HK$ 500

1.5 Days Symposium íV Student (School of Nursing, HKU) HK$100
1.5 Days Symposium íV Student (The Nethersole School of Nursing, CUHK) HK$100
^ Registration fees include participation in scientific sessions, symposium materials. Lunch will not be provided.


   (C) PAYMENT DECLARATION

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

 

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

(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$.)

I hereby authorize International Conference Consultants Ltd. (ICC Ltd.) to debit my account for the above-mentioned amount.

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. 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
    Symposium.
  4. On/before 30 September 2017

    50% of the registration fee

    After 30 September 2017

    No Refund

  5. The programme is subject to change without prior notice.  In the event of cancellation of the Symposium, 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.
  7. All transactions will be made in Hong Kong Dollar only.
  8. The personal data provided on this Registration Form will be used for enrolment to the symposium and other symposium-related purposes.  The symposium organiser, co-organisers and the event co-ordinator will be able to access such personal data.

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