PHUDA would like to sponsor one member of PHUDA to attend "Harbin Psychiatry Forum" from 18th to 19th April 2012, in Harbin. Our sponsorship will cover Registration fee, Air ticket and Accommodation during forum period for the nominated delegate. Interested applicant please fill in the application form below and fax to 3747 9862 or Email to “momokoyu@yahoo.com.hk ”, Exco of PHUDA.
Application form for Sponsorship of “Harbin Psychiatry Forum" April 18th-19th 2012, in Harbin.
Name:
Membership Number : ______
1. Sponsored through HKPHUDA with last
36 months ○
24 months ○
12 months ○
Never ○
2. Active contribution in the association. If yes, please specify
3. Specialty professional qualification ____________________________________
4. Experience relevant to criteria. If yes, please specify
5. Academic presentation at the conference. If yes, please specify
