Asia Pacific Council of Optometry

The Secretariat of APCO, School of Optometry, The Hong KongPolytechnicUniversity, Hunghom, Kowloon

Tel: (852) 2766 4458 Fax: (852) 2764 7612 Email:

Website:

CONGRESS REGISTRATION FORM

17th Asia-Pacific Optometric Congress, 5 – 7 November, 2009

Early Bird Registration Deadline: 15 August 2009

Registration Deadline:15October 2009

Part A: Personal Details Please complete this form in BLOCK letters.

Title:Prof. Dr. Mr. MsGender: MF
Given name: / Surname:
Position: / Department:
Institution / Organization:
Address:
City: / State/Province:
Country: / Postal Code:
Tel: () / Fax: ()
E-mail:
Dietary Requirement: Vegetarian / Submission of abstract / Poster: Yes No

Part B: Ticket Order Details

Please select the appropriate boxes and indicate the no. of ticket required.

Ticket Type / No. of Ticket / Unit Price
Early Bird Ticket (by 15August 2009 (postmark) / USD 315
Full ticket / USD 350
Group ticket
(for each order of 10 or more full tickets) / USD 315
One day ticket(maximum for 2 days)
Please select the datethat youwill attend
5 Nov 2009 (Thursday)
6 Nov 2009 (Friday)7 Nov 2009 (Saturday) / USD 100
Postgraduate student ticket(see note below) / USD 100
Gala dinner ticket / USD 100
Early Bird Ticket
Full Ticket
Group Ticket / The registration fee includes 3 days participationin the lectures, scientific paper, industrial sessions, poster session, coffee breaks, lunches, Gala Dinner and Farewell Party.
One Day Ticket / The registration fee includes participation in the lectures, scientific paper, industrial sessions, poster session, coffee breaks and lunch on the specified date only.
Postgraduate Student Ticket / The registration fee includes 3 days participation in the lectures, scientific paper and industrial sessions, poster session and coffee breaks. Registration must be accompanied with the proof of student status issued by the school or college.

Registration deadline: 15 October 2009 (postmark)

Registration is valid only upon receipt of full payment.

Part C: Payment Methods

Please select the appropriate boxes and fill in the required information.

I have enclosed aUSDollarsbank draft payable to “Asia-Pacific Council of Optometry” in the amount of USD as the registration fee for of persons.

Name of Bank:

Draft No.:

I have enclosed a crossed cheque in Hong KongDollars payable to“Asia-Pacific Council of Optometry” in the amount ofHKD as the registration fee for of persons.

Name of Bank:

Cheque No.:

(For Hong Kong residents only)

Signature: ______Date:

Please completethe registration form and return it with appropriate registration feeto the following address.

The Secretariat of the AsiaPacific Council of Optometry

School of Optometry

The Hong KongPolytechnicUniversity

Hunghom, Kowloon

Hong Kong

Attn: Ms. Ivy Yeung

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