The Chinese University of Hong Kong ENT Conference 2014

Repertoire Essentials of Head & Neck Surgery

(5-7 December)

Post Conference Workshop

Hong Kong Head and Neck Surgery Dissection and Reconstruction Course 2014

(7-10 December)

Hong Kong

Organizer Department of Otorhinolaryngology, Head and Neck Surgery

The Chinese University of Hong Kong

Supporting Organization

The Hong Kong College of Otorhinolaryngologists

The Hong Kong Society of Otorhinolaryngology, Head and Neck Surgery

Hong Kong Head and Neck Society

The Hong Kong Society of Reconstructive Microsurgeons


Conference Chairman & Course Director:

A C Vlantis Associate Professor, Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong

International Faculty:

Johan Fagan Professor and Chairman, Division of Otolaryngology, Head & Neck Surgery, University of Cape Town, South Africa

Jesus Medina Immediate Past President, The Triological Society ; Professor, Department of Otorhinolarynoglogy, The University of Oklahoma, USA

Yi Xin Zhang Assistant Chief, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China

Henri Marres Professor of Otorhinolaryngology, University of Nijmegen, The Netherlands

Registration Fee (HK$):

Main Conference*
On or before 26 October / On or after 27 October
ENT Specialist / $2,500 / $2,250* / $3,000 / $2,700*
Trainee (proof required) / $1,500 / $1,350* / $2,000 / $1,800*
Nurse and Allied Health / $800 / $720* / $1,000 / $900*
Nurse of Hospital Authority Hong Kong / $500 (excludes conference dinner) / $500 (excludes conference dinner)
Specialist from Mainland China / $1,300 / $1,800
Accompany Person at Conference Dinner / $600 / $600

*A discount of 10% will be offered to fellows and members of the supporting organizations registering for the Main Conference. All registered delegates will be entitled to tea refreshments, lunches during the conference, and to the conference dinner on 5 December 2014.

Post Conference Course
Dissector : HKD22,000 / Observer HKD6,000
Ø  Lectures, demonstration dissections, delegate dissections / Ø  Lectures and demonstration dissections only
(no observer dissection)
Ø  There will be a maximum of 18 dissectors / Ø  There will be a maximum of 18 observers
Ø  Places for dissector and observer will be confirmed upon receipt of payment
Ø  A 100% discount / waiver of the conference registration fee will be given to Course participants

Accreditation:

Hong Kong College of Otorhinolaryngologists

-  Conference : 12 CME points (Cat. 2) for whole conference

-  Workshop :

Dissector – 7 CPD points (Cat 14) per day ; maximum 20CPD points (Cat. 14) for whole workshop

Observer – 7 CME points (Cat. 2) per day ; maximum 20 CPD points (Cat. 2) for whole workshop

Hong Kong College of Surgeons (pending)

MCHK CME Programme, Accredited by HKAM (pending)

Secretariat:

Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong

Tel: (852) 2632 1277 Fax: (852) 2145 8876

Email:

Website: www.ent.cuhk.edu.hk/entconf2014


The Chinese University of Hong Kong ENT Conference 2014

and

Hong Kong Head and Neck Surgery Dissection and Reconstruction Course 2014

Registration Form

Complete this registration form in BLOCK LETTERS and return it with the appropriate registration fee to the Secretariat (we accept fax and on-line registration for credit card payment). Places will be confirmed on receipt of completed registration form and full payment.

Title □ Prof □ Dr □ Mr □ Mrs □ Ms

Surname ______Name ______

Institution ______

Mailing Address ______

______

Tel ______Fax ______

Email ______

Member of Supporting Organization : □ Yes (pls specify)______□ No

Accompanying Person □ Mr □ Ms Name ______

Registration category

Main Conference (5-7 December 2014)*
On/Before
26 October / On/ after
27 October
¨ ENT Specialist / $2,500 / $2,250* / $3,000 / $2,700*
¨ Trainee (proof required) / $1,500 / $1,350* / $2,000 / $1,800*
¨ Nurse and Allied Health / $800 / $720* / $1,000 / $900*
¨ Nurse of Hospital Authority Hong Kong
/ $500 (excludes conference dinner) / $500 (excludes conference dinner)
¨ Specialist from Mainland China / $1,300 / $1,800
Post Conference Course (7-10 December 2014)
A 100% discount / waiver of the conference registration fee will be given to Course participants
¨ / Dissector - Lectures, demonstration dissections, delegate dissections / $22,000
¨ / Observer - Lectures and demonstration dissections only (no observer dissection) / $6,000
Others
¨ / Accompanying person/s
(fee includes conference dinner) / HK$600 per person x _____
Grand Total / HK$

*A discount of 10% will be offered to fellow and members of the supporting organizations registering for Main Conference. Registered delegates will be entitled to tea refreshments, lunches during the conference, and conference dinner on 5 December 2014.

Dietary Preference : ¨ Regular ¨ Vegetarian ¨ Others (pls specify ______)

Payment Method

□ A bank draft for USD/HKD made out to “The Chinese University of Hong Kong” is enclosed.

(Personal cheques are acceptable for HK residents ONLY)

□ Please debit my credit card: Type: Visa / Master* (*delete as appropriate)

Name ______

Card Issuing Bank ______

Card No ______-______- ______-______Expiry date ____/____

Amount USD/HKD ______

Signature ______Date______


Payment, Cancellation and Refund Policy

Ø  Please note that full payment must be received with the completed registration form.

Ø  All cancellation requests must be made in writing to the Secretariat. The following refund policy will be applied:

Postmarked, faxed or email on or before
9 November / Refund of registration fee less an administration charge of HK$450
Postmarked, faxed or email after 9 November / No refund

Should the Conference / Course scheduled have to be cancelled due to unforeseeable circumstances, the organizer will try and reschedule the programme whenever possible. There will be no refund if a delegate cannot attend the re-scheduled programme. If, for reasons beyond the control of the Organizing Committee, the Conference / Course is cancelled, registration fees will be refunded after deduction of conference expenses already incurred.

Remarks to Participants of Dissection Course

Ø  Instruments will be provided.

Ø  Two participants will share one cadaver.

Ø  Space on the course is limited and enrolment is considered only after receipt of registration form with payment.

Protection of Personal Data

¨ Please note that your personal data we retain is used only for direct marketing purposes relating to organizing, coordinating and carrying out activities, solicitation of donations, to support or encourage charitable and/or health related works by the Department of Otorhinolaryngology, Head and Neck Surgery, CUHK, and to promote such works. Please tick if you wish to opt-out from receiving our information materials.

Conference Secretariat

Department of Otorhinolaryngology, Head and Neck Surgery,

The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. Hong Kong

Tel: (852) 2632 1277 Fax: (852) 2145 8876 Email:

Website: www.ent.cuhk.edu.hk/entconf2014