The 9th Hong Kong Allergy Convention (HKAC 2016)
8-9 October 2016Hong Kong Convention and Exhibition Centre

Registration Form

Registrants are advised to read the registration information at before submission.

Please complete the Form below and return it with the appropriate payment to:

HKAC 2016 Secretariat
c/o International Conference Consultants Ltd.
Unit C-D, 17/F, Max Share Centre, 373 King's Road, North Point, Hong Kong
Tel: (852) 2559 9973 Fax: (852) 2547 9528 Email: bsite:

You are highly recommended to register online at

(A)PERSONAL INFORMATION * Mandatory Fields (Please type or print in block letters and  where appropriate)

Title:* Prof. Dr. Mr. Mrs. Ms. Others, please specify:

Last Name:*First Name:*

Position:*Department:

Organization:*

Address:*

City/State: Postcode:Country:*

Tel:* / Fax: / Email:*
(country code) (area code) number (country code) (area code) number / (Email is required for future communication)

Dietary Requirement: Vegetarian Allergic to Food (Please specify: ______)

(B)REGISTRATION FEE
Category / Early-Bird Rate
(On or before 9 September 2016) / Regular Rate
(After 9 September 2016)
Members: Medical Practitioners* / HK$780 (US$100) / HK$1,560 (US$200)
Non-members: Medical Practitioners / HK$1,560 (US$200) / HK$3,120 (US$400)
Members: Allied Health* / HK$300 (US$40) / HK$600 (US$80)
Non-members: Allied Health / HK$600 (US$80) / HK$1,200 (US$160)
Delegates from Mainland China and Macau / HK$780 (US$100) / HK$1,560 (US$200)
Postgraduate Students^ / HK$300 (US$40) / HK$600 (US$80)
Undergraduate Students^ / Complimentary
Others / HK$1,560 (US$200) / HK$3,120 (US$400)

* Members refer to all categories of membership of the Hong Kong Institute of Allergy (HKIA), American College of Allergy, Asthma & Immunology (ACAAI), British Society for Allergy & Clinical Immunology (BSACI) and European Academy of Allergy & Clinical Immunology (EAACI).

^(i) E-copy of your student ID card or (ii) Certifying Letter from your supervisor orInstitution is required to qualify for“PostgraduateStudents“or“Undergraduate Students” fee.(Offers are subject to quota, it will be allocated on a first-come-first-served basis).

Please indicate the lunch(es) that you will join: (As space is limited, it will be allocated on a first-come-first-served basis):

Lunch on 8 October 2016 Lunch on 9 October 2016

(C)PAYMENT DECLARATION

I hereby agree to be bound by the rules and regulations of the Convention and would like to settle the payment (Part B) in HK$ by:

Cheque (in Hong Kong dollars only)made payable to “The Hong Kong Institute of Allergy”

Credit Card (in Hong Kong dollars only): VISA MasterCard

(Please contact your credit card company to notify them of this international charge to prevent the transaction from being rejected. The merchant name shown on the statement will be “ICC LTD” and the amount charged will be in HK$.)

I hereby authorize International Conference Consultants Ltd. (ICC Ltd.) to debit the above-mentioned amount from my card.

Card Number: - - - Expiry Date (MM/YY): -

Name of Cardholder:

Signature:Date:

If you are not using personal credit card to pay, please fill in the following details of the cardholder.

Contact Email: Contact Phone Number:

Rules and Regulations:

  1. Each registrant should complete a separate Registration Form.Online registration is highly recommended. Photocopy of the Registration Form is acceptable.
  2. Registration Form without payment will NOT be processed. Please do NOT send cash.
  3. The HKAC 2016 Secretariat will send a registration confirmation by email upon receipt of your Registration Form and full payment. Kindly check the confirmation. Any changes or alterations must be made in writing to the HKAC 2016 Secretariat.
  4. Refund for cancellation of registration will be made and subject to the following deadline and administrative charge:

On or before 9 September 2016 / 50% of the registration fee
After 9 September 2016 / No refund
  1. The Convention programme is subject to change without prior notice. In the event of cancellation of the Convention, the only liability of the Organizers is to refund all the fees paid.
  2. All enquiries, changes and cancellations should be made in writing to the HKAC 2016 Secretariat.
  3. The information on this Form is to assist us in preparing your participation in the Convention. All the information you provide will be restricted to the Organizers of HKAC 2016 and other related working parties. You have the right of access and correction with respect to your personal data held by us. If you wish to exercise these rights, please contact the HKAC 2016 Secretariat.