8th World Chinese ENT Surgery Conference Application Form of Attendance Certificate

8^th World Chinese ENT Surgery Conference
Application Form of Attendance Certificate

Please visit the webpage before filling the registration form.

Request to issue attendance certificate (for online or onsite participant)

Participants with 2 days of physical conference attendance are eligible for attendance certificate charge waiver. Your credit card will not be charged. Please contact registration desk for details.

HK$1,000- for Hong Kong doctors
HK$400- for audiologist / speech therapist / allied health / others
HK$300- for overseas / non-Hong Kong doctors

Personal Information
Salutation

Salutation Prof Dr Mr Mrs Miss Ms
Full Name Full Name * First Last
Email Address *
Mobile Number *
Registration
Please indicate your organization for reporting attendance *

Please indicate your organization for reporting attendance The Hong Kong College of Otorhinolaryngologists The College of Surgeons of Hong Kong Hong Kong College of Radiologists Non-specialist Hong Kong Society of Audiology Hong Kong Association of Speech Therapists NIL Other Other
Category *

Category 1 Dec 2022 (Pre-conf Surgery Video Demo) 2-4 Dec 2022 (Main Conference)
How should your name appear on the Attendance Certificate? *
Credit Card Information
Type of Credit Card *

Type of Credit Card VISA Master
Name shown on Credit Card *
Credit card number *
Must be 16 characters. Currently Entered: 0 characters.
Date (Month) of Expiry *
Date (Year) of Expiry *
Questionnaire
Please indicate how you heard about this event. *

Please indicate how you heard about this event. At past The Chinese University of Hong Kong events such as conferences, workshops or courses By word of mouth Department's webpage Promotional email Facebook WeChat Others Others
Protection of Personal Data

The Department of Otorhinolaryngology, Head and Neck Surgery of The Chinese University of Hong Kong (“Department”) organizes academic and educational activities. The Department intends to use the personal data (i.e. your name, email and mailing addresses and contact number) you provided in this form for the purpose of sending you the Department’s promotional and educational information.

Event participants have the right to request access to and correction of their personal data held by the “Department”. Please send the request to Course Secretariat by fax (852) 2145 8876, by email at entconf@ent.cuhk.edu.hk, or by mail to the Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Please click the button to indicate your consent. *

Please click the button to indicate your consent.
I agree that “Department” uses my name, email address and contact number (if applicable) for the purpose of sending me Department’s promotional and educational information.

I do not wish that “Department” uses my name, email address and contact number (if applicable) for the purpose of sending me Department’s promotional and educational information.
Disclaimer The personal data collected will be used by Dept of Otorhinolaryngology, Head and Neck Surgery_Admin - MED (OHNS_ADM_ENT_MED) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

8th World Chinese ENT Surgery Conference Application Form of Attendance Certificate

Personal Information

Registration

Credit Card Information

Questionnaire

Protection of Personal Data

8^th World Chinese ENT Surgery Conference
Application Form of Attendance Certificate