Advances in Facial Plastic Surgery and Rhinology
and Pre-conference Cadaveric Workshops
Prince of Wales Hospital, Hong Kong
(1) Complete this registration form in BLOCK LETTERS and return with the appropriate registration fee to the Secretariat; OR
(2) Register online at our website www.ent.cuhk.edu.hk/entconf2011
Salutation: Professor Doctor Mr. Ms.
Surname: Given Name:
Facial Plastic Rhinology/Skull Base Plastic, Reconstructive and Aesthetic Surgery
Subspecialty Oral and Maxillofacial Surgery Others_____________________________
I am a member of the Pan Asia Academy of Facial Plastic & Reconstructive Surgery / American Academy of Facial &
Plastic Reconstructive Surgery / European Academy of Facial Plastic Surgery / Brazilian Academy of Facial Plastic
Surgery / Mexican Society of Rhinology & Facial Plastic Surgery / Australasian Academy of Facial Plastic Surgery.
(delete as appropriate)
I am a delegate from Asia / Australasia region.
I am most interested in the Facial Plastic Programme Rhinology/Skull Base Programme (please tick one for our
conference logistic arrangement.)
Main Conference (7 - 9 December 2011)
On or before 1 Sep After 1 Sep
Member of Pan Asia Academy of FPRS / American Academy of
FPRS / European Academy of FPS / Brazilian Academy of FPS /
Mexican Society of Rhinology & FPS / Australasian Academy HK$3,000 HK$4,000
Delegate from Asia / Australasia region
Delegate from other regions HK$4,000 HK$5,000
Trainee (Proof required) HK$2,000 HK$2,500
Pre-conference Cadaveric Workshop
Rhinoplasty Dissection Course (5 December 2011) HK$15,000
Grand Total HK$
Credit Card Payment Visa MasterCard Card Issuing Bank
Surname Given Name
Expiry Date (mm/yyyy) Amount HK$
Signature of Cardholder
A bank draft for HK$______________ payable to "The Chinese University of Hong Kong".
Personal cheque for the amount of HK$ ________________ made payable to "The Chinese University of Hong Kong". (For
Hong Kong residents only)
Signature of Applicant Date
Remarks to Participants of Rhinoplasty Workshop:
Instruments will be provided but course delegates are welcome to bring their own instruments. Please kindly
inform the secretariat if you wish to do so for inventory purposes.
Two participants will share one cadaver head.
All participants will agree to follow Professor Palma’s step-by-step command so as to fully understand the
rhinoplasty dissection. Participants are to perform each step as group without deviation.
Local faculty will be present to supervise dissection tables.
Limited places granted on a first-come-first-served basis to the following specialty surgeons with an interest in
ENT and Facial Plastic Surgeon
Plastic, Reconstructive and Aesthetic Surgeon
Payment, Cancellation and Refund Policy:
Please note that full payment must be received for early bird fee no later than 1 September 2011 to ensure you
receive the early bird discount. After that date, unpaid early bird registrations will automatically be increased to the
All cancellations must be made in writing to the Secretariat. The following refund policy will be observed:
Refund of registration fee less an
Postmarked, faxed or email on or before 1 September administration charge of HK$450
Postmarked, faxed or email after 1 September No refund
Should the programme scheduled have to be cancelled due to unforeseeable circumstances, the organizer shall try
to re-schedule the programme whenever possible. There will be no refund if the delegate cannot attend the re-
scheduled programme. If, for reasons beyond the control of the Organizing Committee, the 2011 CUHK ENT
Conference, and/or its pre-conference workshops are cancelled, registration fees will be refunded after the
deduction of conference expenses already incurred.
Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong
6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong
Tel No. : (852) 2632 1277
Fax No. : (852) 2145 8876
Email : firstname.lastname@example.org
Website : www.ent.cuhk.edu.hk/entconf2011