APPLICATION FORM (Group)

HONG KONG PHYSIOTHERAPY ASSOCIATION PAEDIATRIC SPECIALTY GROUP

Seminar: Adaptive Physical Education for Individuals with Disabilities or Special Needs Date: 3rd June, 2008 (Tuesday) Time: 6:30 – 8:30pm Venue: Auditorium, 4th Floor, Jockey Club School Dental Clinic, 147J, Argyle Street, Kowloon.

Please fill this form in BLOCK letters: Name *HKPA *#PSG Cheque *Attendance (English & Chinese) Member. no. member (if applicable) Certificate  Yes  Yes Bank ______ required  No  No No. ______ not required  Yes  Yes Bank ______ required  No  No No. ______ not required  Yes  Yes Bank ______ required  No  No No. ______ not required  Yes  Yes Bank ______ required  No  No No. ______ not required  Yes  Yes Bank ______ required  No  No No. ______ not required  Yes  Yes Bank ______ required  No  No No. ______ not required * Indicate by a ‘√ “ # Status of membership is based on the updated list from HKPA and is counted up to the date of deadline of application

Place of work: ______Representative Name: ______Telephone: ______Fax : ______Email: ______

Send the application form either:

1. By email to [email protected]. (Downloadable form from: http://www2.rs.polyu.edu.hk/psig/APE_Application_Group.doc or, http://www2.rs.polyu.edu.hk/psig/APE_Application_individual.doc ),

2. By fax to 27627754, attention to Ms. Au Mei Kuen,

3. By mail for those who need payment. Receipt will be given out onsite. Send the application form together with a cheque payable to ‘Hong Kong Physiotherapy Association Limited’ (with name & contact no. at the back) to: Ms Au Mei Kuen (Physiotherapist) 1/F, Physiotherapy Department Kowloon Hospital Rehabilitation Building 147A Argyle Street, Kowloon.

 Unsuccessful applicant(s) will be notified by email.