The Hong Kong Practitioner VOLUME 24 / November 2002

THE HONG KONG COLLEGE OF FAMILY PHYSICIANS

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2002 Annual Refresher Course
November 25 - December 8, 2002

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REGISTRATION FORM


H.K.C.F.P.
Room 701, 7th Floor
Hong Kong Academy of Medicine Jockey Club Building
99 Wong Chuk Hang Road, Aberdeen, Hong Kong

Dear Sir,

I am a(an) *Student / Affiliate / Associate / Full / Fellow / Overseas / Non-Member of the Hong Kong College of Family Physicians.

 

The whole course:-
eight Luncheon Lectures and two Workshops
(including fee for Certificate of Attendance) 		  Member : HK$1,000.00 (   )
HKAM Registrant : HK$2,000.00 (   )
Non-member : HK$3,000.00 ( )
             
Spot admission fee for each
Luncheon Lecture or Workshop is: 		Member : HK$200.00 (   )
HKAM Registrant : HK$300.00 (   )
Non-member : HK$400.00 ( )
             
Enclosed please find a cheque (made payable to "HKCFP Foundation Fund") of HK$ _______________ being payment in full for the above.
 
 
 

SIGNATURE

: ___________________________________
     
NAME : ___________________________________
    (Block Letters, Please)
     
ADDRESS : ___________________________________
   
    ___________________________________
     
TEL. NO. : ___________________________________
     
DATE : ___________________________________
     
*Please circle your category of membership.