香港药剂学术

HONGKONGPHARMACYCONFERENCE2010RegistrationFormPersonalDetails(PleasefillinwithBLOCKLETTERSandtick√whereappropriate)#Title:□Prof.□Dr.□Mr.□Ms.□Mrs.#Surname:_____#Givenname:#Correspondenceaddress:#ContactTelNo:_____________FaxNo:_____________#E-mailaddress:Workingfield:□Community□Education□Government□Hospital□Industry□Student□OthersNameofworkplace:Addressofworkplace:Membership:□ThePharmaceuticalSocietyofHongKong(PSHK)MembershipNo.□TheSocietyofHospitalPharmacistsofHongKong(SHPHK)MembershipNo.□ThePracticingPharmacistsAssociationofHongKong(PPA)MembershipNo.#CompulsoryfieldsRegistrationFeeEarly-Bird*RegistrationFee(before1stDec2009)FullRegistrationMember(PSHK/SHPHK/PPA)Non-member□HK$1100□HK$1300□HK$900□HK$1100PartialRegistrationDay1lecturesonlyDay2only(includesday2breakfast&lunch)Day1lecturesandDay2only(includesday2breakfast&lunch)Conferencedinneronly□HK$400□HK$550□HK$800□HK$800□HK$600Specialoffer**Day1lecturesandDay2only(includesday2breakfast&lunch)□HK$300Affiliation:(pleaseindicate)ASPsponsorshipcandidates***Fullregistration□Free*Toreceivetheearly-birddiscount,yourregistrationmustbepostmarkedonorbefore1stDec2009.TheConferenceOrganizingCommitteereservestherighttoallfinaldecisionsrelatingtodiscounts.ForlocalregistrantsinHongKongonly:**StrictlyforregistrantsifaffiliatedtolocalundergraduatesofPharmacy,Medicine,Nursing,orChineseMedicine,studentsofHigherDiplomainPharmaceuticalTechnology(HKIVE),pharmacyinterns,andmembersofPharmaceuticalStaffAssociation(PSA),PharmacyTechniciansAssociation(PTA)orHongKongSocietyofPharmaceuticalTechnologyandHealthCareProfessionals(PTHeP).Theaffiliationmustbestatedintheformtobeeligibleforspecialofferconsideration.***StrictlylimitedtocommunitypharmacistswhoaresponsoredbytheirownAuthorizedSellersofPoisons(ASPs)throughtheASPsponsorshipprogram.Iftheregistrationformandthepaymentaresentafter9thJan2010,yourregistrationkitwillbearrangedason-sitepickup.PaymentIencloseaBankDraft/ChequeNo._________________________ofHK$________________Payableto‘TheSocietyofHospitalPharmacistsofHongKongLtd’.Pleasecompletetheregistrationformandsendittogetherwithyourpaymentto:‘HongKongPharmacyConference2010,POBox90155,TsimShaTsui,Kowloon,HongKong.’香港药剂学术年会2010登记表格个人资料(请填写清楚及在适当方格内填上√号)#头衔:□教授□博士□先生□小姐□女士#姓:_________#名:#通讯地址:#聯络电话:_______________传真:_______________#电邮:工作界别:□社区□教育□政府□医院□工业□学生□其它公司名称:公司地址:会籍:□香港药学会(PSHK)会员号码:__________________________□香港医院药剂师学会(SHPHK)会员号码:__________________________□香港执业药剂师协会(PPA)会员号码:__________________________#必须填写登记费用预早登记优惠*登记费用(2009年12月1日前登记)整个学术年会会员(PSHK/SHPHK/PPA)非会员□港币$1100□港币$1300□港币$900□港币$1100参加部份项目只參加第1日听课只參加第2日(包括第2日的早餐及午餐)只參加第1日听课及第2日(包括第2日的早餐及午餐)只參加晚宴□港币$400□港币$550□港币$800□港币$800□港币$600特别优惠**只參加第1日听课及第2日(包括第2日的早餐及午餐)□港币$300优惠身份:(请注明)药房赞助计划参加者***包括整个学术年会□免费*如阁下于2009年12月1日前登记参加学术年会，可享预早登记优惠，日期以邮戳日期为准。主办单位保留所有优惠的最终决定权。以下两项只适用于香港本地参加者：(特别优惠/药房赞助计划参加者只适用于香港申請者)**只限于药剂学、医学、护理学及中医药学的本科生、香港专业教育学院制药及配药高级文凭学生、药剂实习生、药剂职员会(PSA)会员、药剂技术员协会(PTA)会员或香港药剂科技及保健专业人员学会(PTHeP)会员。请于上方填上所属机构及身份以享有优惠。***只限于药房赞助计划中由所属药房赞助的社区药剂师。所有參加者的登记表格及费用如于截数日二零一零年一月九日后寄出，请于年会举行当日于登记处领取确认登记包。付款办法随函付上银行本票/支票号码_________________________港币$________________抬头为‘香港医院药剂师学会有限公司’请确保已填妥此登记表格并夹上银行本票/支票寄回:香港九龍尖沙咀邮政信箱90155号香港药剂学术年会2010