27th Annual Certificate Course on Respiratory Medicine

27^th Annual Certificate Course on Respiratory Medicine - Registration Form

Date: 25^th November 2025 (Tuesday)
Venue: Shaw Auditorium, School of Public Health Building, Prince of Wales Hospital, Shatin.

Salutation

Salutation Prof. Dr. Mr. Ms. Mrs.
Surname (e.g. CHAN)
Given Name (Tai Man Peter)
Working Hospital / Institute (In Full Name)
Speciality / Working Area

Speciality / Working Area Medical Surgical Oncology Pediatrics A&E Physiotherapy Occupational Therapy Dietitian Pharmacy Other Other
Profession

Profession Nurse Allied Health Professionals Other Other
Nurse

Nurse Enrolled Nurse Registered Nurse Advanced Practice Nurse Other Other
Allied Health Professionals

Allied Health Professionals Occupational Therapist Physiotherapist Pharmacist Other Other
Contact Phone Number 1
Contact Phone Number 2
Email Address

Confirm Email Address
Working Address
(Certificate of Attendance will be mailed to you ~ 8 - 10 weeks after the course)
Payment method:
1. Only cheque payment is accepted.
2. Cheque should be payable to "The Chinese University of Hong Kong"
3. Please write your FULL NAME and CONTACT NUMBER at the back of the cheque.
4. You will receive an email after submission of application with your information on it.
5. Please send the cheque together with your application information to the following address:

Attn: Ms. Maureen Yeung
Department of Medicine & Therapeutics,
9/F, Lui Che Woo Clinical Sciences Building,
Prince of Wales Hospital,
Shatin, N.T., HK

6. Application fee received is neither refundable nor transferrable.
7. Successful applicant will receive a confirmation email, which also serves as an official receipt of your registration.
Cheque number
Must be 6 characters. Currently Entered: 0 characters.
Issuing bank
Remarks: Lunch will not be provided.
Disclaimer The personal data collected will be used by Division of Respiratory Medicine and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

27th Annual Certificate Course on Respiratory Medicine - Registration Form

Remarks: Lunch will not be provided.

27^th Annual Certificate Course on Respiratory Medicine - Registration Form