Registration Form Symposium On: "Cancer Control: Challenges

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Co-organized by & OTHERS Registration Form Symposium on: "Cancer Control: Challenges & Opportunities" Date: 7 December 2013 (Saturday) Time: 9:00 am - 5:45 pm Venue: Auditorium, 8/F, HK Federation of Youths Group Building, 21 Pak Fuk Rd, North Point, Hong Kong (MTR Quarry Bay Station, Exit C) Target: Healthcare and related professionals including doctors, radiation therapists, nurses, paramedical professionals, social workers and counselors, hospital administrators in public, private and NGO sectors service providers. Academics from tertiary institutes and students in related fields. All are welcome. Language: Cantonese & English Registration Fee: Symposium Lunch at Harbour Plaza North Point Hotel All University Students Free Admission HK$50 All Applicants Free Admission HK$100 Lunch Arrangement: Lunch at Harbour Plaza Lunch will be held at Hoi Yat Heen Chinese Restaurant, North Point Hotel: Harbour Plaza North Point Hotel. 5 minutes walking distance from venue. Chinese cuisine will be served. CME / CNE Accreditation: MCHK CME Program: 4 CME (accredited by HKAM); Physicians: 4 CME; Surgeons: 4 CME. Community Medicine / Family Physicians / Obstetricians & Gynaecologists / Radiologists are pending. Nurses: 6 CNE. Attending participants will be awarded Certificate of Attendance. First come, first served. Please return the completed registration form to our Secretariat. Please visit our website www.hkacs.org.hk for online registration or downloading registration forms. Secretariat: The Hong Kong Anti-Cancer Society 30 Nam Long Shan Road, Wong Chuk Hang, Hong Kong Tel: (852) 3921 3821 Fax: (852) 3921 3822 E-mail: [email protected] Registration Form Symposium on: "Cancer Control: Challenges & Opportunities" I. Personal Details (please use block capitals) Title: Prof. / Dr. / Mr. / Mrs. / Ms. Last Name: ____________________________ First Name: ____________________________ Position: ________________________________________________________________________ Department / Section / Unit: ___________________________________________________________ Organization / Institute: ___________________________________________________________ Mailing Address: ___________________________________________________________ Telephone: ____________________________ Facsimile: ____________________________ Email: ________________________________________________________________________ II. Registration Fees Please where appropriate Symposium Lunch at Harbour Plaza North Point Hotel All University Students Free Admission HK$50 All Applicants Free Admission HK$100 III. Method of Payment Cheque made payable to “The Hong Kong Anti-Cancer Society” to be enclosed with registration form. Please write down name of applicant on back of cheque. IV. Deadline for Application 30 November, 2013 (Saturday) V. Location Auditorium 8/F, HK Federation of Youths Group Building 21 Pak Fuk Road North Point, Hong Kong (MTR Quarry Bay Station, Exit C) .

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