WFN RG ADCD 2014 | Registration Form

The fields below with asterisk ( * ) must be filled in.

*Title:

Professor

Dr.

Mrs

*Family Name / Surname:

*Given Name / First name:

*Occupation:

Department:

Institution:

*Mailing Address:

*Country:

*Tel:

Fax:

*E-mail:

Total Amount: 0 HKD

Cheque (For local registrants only)

Please prepare a cheque made payable to “The Chinese University of Hong Kong” and mail it to:

Mr. Hermes Wong, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong.

Please write down your name and contact number on the back of the cheque.

Credit card

Please fill in and sign the Credit Card Payment Authorization Form. Return it via Fax: (852) 2145 7237 or
Email (the scanned copy): wfnrgadcd2014@cuhk.edu.hk

Members	2750 HKD (approx. 250 Euro / 345 USD)
Non Members	3300 HKD (approx. 300 Euro / 415 USD)
FYRE Members	2200 HKD (approx. 200 Euro / 275 USD)

Date	Category 1	Category 2	Category 3
Day 1 (Thu 27th Nov 2014 afternoon) - Including 1 coffee break	50 HKD	100 HKD	150 HKD
Day 2 (Fri 28th Nov 2014) - Including lunch & 2 coffee breaks	100 HKD	200 HKD	250 HKD
Day 3 (Sat 29th Nov 2014) - Including lunch & 2 coffee breaks	100 HKD	200 HKD	250 HKD
Day 4 (Sun 30th Nov 2014) - Including lunch & 2 coffee breaks	100 HKD	200 HKD	250 HKD
All four days above - Including all lunches & coffee breaks	300 HKD	600 HKD	750 HKD

Welcome Dinner (Thu 27th Nov 2014 evening) - Lake Egret Nature Park Centre, Tai Po	400 HKD (approx. 37 Euro / 50 USD)
Harbour Cruise Dinner (Sat 29th Nov 2014 evening) - 3 hours, embarkation at North Point	800 HKD (approx. 73 Euro / 100 USD)