<p> APPLICATION FORM (Group)</p><p>HONG KONG PHYSIOTHERAPY ASSOCIATION PAEDIATRIC SPECIALTY GROUP</p><p>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.</p><p>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</p><p>Place of work: ______Representative Name: ______Telephone: ______Fax : ______Email: ______</p><p>Send the application form either:</p><p>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 ),</p><p>2. By fax to 27627754, attention to Ms. Au Mei Kuen,</p><p>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.</p><p> Unsuccessful applicant(s) will be notified by email.</p>