questionnaire

Reservation :

I would like to reserve a seat and to receive information on
future courses/activities, here is my contact information :

Title :

Sex :

Name : In English
              Christian Name
              Middle Name1
              Middle Name2
              Surname Name
              In Chinese

Occupation
Others, please specify

For Practicing Doctors, MCHK Registration No.

College Membership (please specify) :
Department of Health, HKSAR
Hong Kong Academy of Medicine
Hong Kong Doctors Union
The Hong Kong Medical Association
Hong Kong College of Paediatricians
Hong Kong College of Physicians
The Hong Kong College of Family Physicians
The Hong Kong College of Obstetricians and Gynaecologists
Hong Kong College of Community Medicine
The College of Surgeons of Hong Kong
The Hong Kong College of Pathologists
The Hong Kong College of Psychiatrists
Hong Kong College of Radiologists
College of Nursing, Hong Kong
Pharmacy Central Continuing Education Committee
    The Practising Pharmacists Association of Hong Kong
    The Society of Hospital Pharmacists
    Pharmaceutical Society of Hong Kong
Institute of Advanced Nursing Studies
Hong Kong Podiatrists Association
Hong Kong Dietitians Association
Hong Kong Physiotherapy Association
      Others, please specify

Department :

Institution/Organisation :

Room and Building :
Street :
District/Postal Code :
Country :

Telephone (Office) :
Telephone (Home) :
Fax :
Mobile:
Pager :
E-mail address :

Press to submit the form.