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Are you a local or non-local applicant? *
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Section 1: Personal Information
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Title *
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Section 2: Enrollment
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I would like to register to the following event(s):
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Registration Fee
Knowledge Event - Health System and Community Resilience: Lessons From The COVID-19 Pandemic (4 December 2023) ONLY -- Free
Policy Course on Health System Private Sector Engagement for Primary Care Led Integrated-Seamless Health Care Intervention (5-7 December 2023) ONLY-- Registration Fee: USD 350; Early Bird - USD 300 (before 1 November 2023); Group of at least 3 persons - USD 300 per person; Undergraduate and postgraduate students - USD 100 per person (upon Proof of Study Documentation)
Both Events -- Registration Fee:
Knowledge Event (4 December 2023) -- Free
Policy Course (5-7 December 2023) -- USD 350; Early Bird - USD 300 (before 1 November 2023); Group of at least 3 persons – USD 300 per person; Undergraduate and postgraduate students - USD 100 per person (upon Proof of Study Documentation)
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Section 3: Poster Presentation for Knowledge Event
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Would you like to submit abstract for poster presentation? *
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Poster submission details
**Please read the Poster Guideline and submit your poster at https://cuhk.qualtrics.com/jfe/form/SV_cVbbfU17erCXbAW
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Section 4: Payment (For those who will join Policy Course)
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Type of registration *
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Full payment must be made within two weeks of the application.
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PAYMENT DETAILS
1) For cheque payment, please make cheque payable to Asia Pacific Network For Health Systems Strengthening Limited and send the cheque to Room 201, 2/F, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong. Attn.: Ms. Christine KO
(Please write your name, contact number and "Application fee for Policy Course" at the back of the cheque)
2) For bank direct transfer/deposit, please make payment to the following bank account with remark on "Application fee for Policy Course":
Account Holder Name : Asia Pacific Network For Health Systems Strengthening Limited
Address : 2/F, School of Public Health Building, 30-32 Ngan Shing Street
Prince of Wales Hospital, Shatin, New Territories, Hong Kong
Account Number : 44719019985 (HKD SAVINGS A/C) OR
44719019993 (USD SAVINGS A/C)
Bank Name : Standard Chartered Bank (Hong Kong) Limited
Bank Address : Payment Centre, 15/F Standard Chartered Tower
388 Kwun Tong Road, Hong Kong
Swift Code : SCBLHKHHXXX
Remarks:
• The registration fee, once paid, is non-refundable or non-transferable.
• Acceptance of application is subject to availability. Acceptance notification will be sent out by 17 November 2023.
• Group discount will only be offered to country team of 3 persons or more, registering at the same time with full payment. Please submit one application form for each participant.
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Section 5: Academic Qualifications – List the highest qualification first (For those who will join Policy Course)
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Section 6: Professional Qualifications (For those who will join Policy Course)
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Section 7: Expectation and Source of Information
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Source of Information *
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I declare that the information given in support of this application is accurate and complete, and understand that any misrepresentation will result in the disqualification of my application for admission.
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The personal data collected will be used by The Jockey Club School of Public Health and Primary Care - Admin Office (SPHPC_ADM) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.