Please Complete This Form in BLOCK Lettersand Return To

Please complete this form in BLOCK LETTERSand return to:

2nd International Brånemark Memorial SymposiumConferenceSecretariat

c/oSwire Travel Ltd. :

Tel: (852) 3151 8900; Fax: (852) 3154 6960

Email:

Section A: Participant Information (* Mandatory)
Title / Prefix: * / Prof Dr Mr Ms
Surname: * / First Name: *
Affiliation: * / Position: *
Region / Country : * / Email: *
Address:
Tel (Work): * / Tel (Mobile):
Section B: Registration
(includes all scientific programmes, refreshment and lunch on 17-18 Nov)
Early Bird
Until 17 July 2017 / Regular
on or after 18 July 2017
Dentist / Specialist / HK$2,550 / US$340 / HK$3,250 / US$433
Dental Student / Trainee
(Document proof is required by email) / HK$1,050 / US$140 / HK$1,300 / US$173
Gala Dinner / HK$500 / US$65
Gala Dinner Menu Option / Beef Fish Vegetarian
Section C: Accommodation (Please  and fill in as appropriate) (All in HK$)
Hotel / Room Type / Room Rate with Daily Breakfast
Single / Twin or Double
(per room per night inclusive of service charge) / No. of Room(s)
Hyatt Regency Hong Kong, ShaTin / Mountain View Room / $1,420 / $1,560
More room types are available. Please contact our Congress Secretariat.
Royal Park Hotel / Standard Room / $1,460 / $1,550
Courtyard By Marriott Hong Kong Sha Tin / Standard Room / $ 920 / $1,020
Other room type or hotel request:
Room Type: Single Double Twin / Smoking Preference: Non-smoking room Smoking room
Check-in Date: (DD/MM/YY) Check-out Date: (DD/MM/YY) No. of room night(s):
Roommate (If any): Special Requirement(s):
Subtotal [C]:

Hotel Reservation Policy:

[1] Full payment is required upon reservation.
[2] Amendments to the reservation must be made by e-mail to Swire Travel Ltd by 15 Jun 2017. And first night payment is non-refundable for cancellation.
[3] Full cancellation penalty would be applied for cancellation made after 30 Sep, 2017.

Section D: One-way Airport Transportation(Please  and fill in as appropriate)
Airport Limousine (Mercedes Benz)
HK$650 per way per limo x of limo
Flight Arrival Date : Flight Arrival Time: Arrival Flight No.:
Subtotal [E]:
Section E: Payment Methods
Credit Card
Credit Card Type: / Visa MasterCard
Card Number:
Expiry Date:
Cardholder Name:
Authorized Amount: / HK$
Authorized Signature:
Bank Transfer / Hong Kong Local Bank Cheque in HK$
Account Name: Swire Travel Ltd
Bank Code: 004
Account Number: 111-016275-002
Bank Name: The Hong Kong & Shanghai Banking Corp Ltd
Bank Address: 1 Queen's Road Central, Hong Kong
Please send a copy of the remittance receipt within 5 days from the issue date by email to or by fax to
(852) 3154 6960and notify us of the name(s) of the participant(s) for reference. All charges on bank transfer will be borne by the sender. / Please make the cheque payable to our Conference Secretariat, “Swire Travel Ltd”, and send to:
Mailing Address:
Swire Travel Ltd.
Unit 501 5/F Tower B
Manulife Financial Centre
223 Wai Yip Street
Kwun Tong
Attn: Rainbow Tam
Registration Policy

FULL PAYMENT for the conference must be received in order to confirm your registration. All payments must reach the Conference Secretariat – Swire Travel Ltd at the time of registration.
For cancellation, please notify the Conference Secretariat:, and please identify the name(s) of the participant(s) and the cancellation items. An administration fee of 50% of the paid registration fee will apply. Refunds will only be made after the completion of BMS 2017. No refund will be entertained for cancellation requests received by the Conference Secretariatafter 30 Sep, 2017.
The organizer reserves the right to change the programmes with/without prior notice.

I have read and agreed to the registration policy set out on this form.

Signature ______Date ______