REGISTRATION FORM

PERSONAL INFORMATION (Please fill in using capital letters)

First Name:*	This field is required. Please fill in.
Middle Name:
Last Name:*	This field is required. Please fill in.
Title:*	Dr. Professor Ms. Mr. This field is required. Please select.
JOB INFORMATION
Position:*	This field is required. Please fill in.	Specialty:*	This field is required. Please fill in.
Institution:*	This field is required. Please fill in.	Department:*	This field is required. Please fill in.
CONTACT INFORMATION
Address:*
Tel No.:*	This field is required. Please fill in. Please provide valid telephone number.	Fax No.:*	This field is required. Please fill in. Please provide valid Fax number.
Mobile:*	This field is required. Please fill in. Please provide valid Moblie number.	Email:*	This field is required. Please fill in. Please provide valid e-mail.

*Mandatory

Registration Fee

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		Early Bird (On or before 30 Sept)	Normal Rate (After 30 Sept)
PSG Workshop (Include Conference )		HKD 4,800	HKD 5,800
Psychotherapy Workshop		HKD 1,000	HKD 1,500
Conference, PSG Workshop & Psychotherapy Workshop		HKD 5,300	HKD 6,300
Conference		HKD 1,200	HKD 1,800
Day Rate	24 Nov (Sat)	--	HKD 1,000
	25 Nov (Sun)	--	HKD 1,000
Total

Methods of Payement *

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	Online payment is encouraged. Have your credit card (VISA/Master) ready and click to proceed to online payment.
	Cheque Cheque is made payable to “The Chinese University of Hong Kong” and send thru registered mail to: Ms Mandy Yu, 7/F, Shatin Hospital, 33 A Kung Kok Street, Ma On Shan, N.T., Hong Kong. Please write your name and registration number on the back of the cheque.
	For bank deposits thru Wire Transfer: The Chinese University of Hong Kong Account number: 293-005005-001 Name and Address of Bank: Hang Seng Bank Limited, Kowloon Main Branch, 618 Nathan Road, Kowloon, Hong Kong Swift code: HASE HKHH Kindly scan the deposit slip or wire transfer copy together with your registration information and email to mandyyu@cuhk.edu.hk

FOR INFORMATION AND REGISTRATION

Confirmation will be sent to all participants by Email after receipt of the registration form with payment. Refund Provided that written notice of withdrawal reaches the Secretariat before 12 September 2018, 50% of the registration fee will be refunded. No refunds will be issued for cancellations after this date or conference nonattendance. Personal Information Collection Statement: The information you provide will be used to update the online registration database, and will be kept strictly confidential. The Organizer may use such data for administrative and communication purposes, but will not disclose any personal information you provide to any external bodies or organizations unless you have been informed or it is required to do so by law. For the University's policy on personal data, please visit http://www.cuhk.edu.hk/policy/pdo/en/.

The registration is now closed.