Inaugural Scientific Meeting of the Hong Kong Society of Interventional Radiology Ltd

16th Annual Scientific Meeting of HKSIR

Date: 29th Oct 2016

Venue: Ballroom, Langham Hotel, 8, Peking Road, Tsim Sha Tsui

Registration form

Personal Information :

Name (English): (¨ Prof. ¨ Dr. ¨ Mr. ¨ Mrs. ¨ Ms. ) ______

(Chinese): ______

Position/ Occupation: Institute: ______

Correspondence Address: ______

______

E-mail Address: (for Confirmation Letter & Attendance Certificate)______

Telephone: _____ Fax : _____

Member/ Associate Member of HKSIR: ¨ YES ¨ NO

Amount
¨ 15th Annual Scientific Meeting of HKSIR Member/ Associate Member / HK$ 50
¨ 15th Annual Scientific Meeting of HKSIR non-Member/ non-Associate Member / HK$ 100

Please send an email to with your full name, department and hospital, if attendance certificate is required.

Attendance Certificate will be issued by email after the symposium

Please send the completed form with crossed cheque (payable to The Hong Kong Society of Interventional Radiology Ltd.) to,

Ms H. Y. Ng

Department of Diagnostic and Interventional Radiology,

Kwong Wah Hospital, 25 Waterloo Road, Kowloon

For more information, please visit www.hksir.org.hk

Signature: ______Date: ______

Extra forms can be photocopied or download from www.hksir.org.hk

Registration No. (for Official Use only) :______