HKODA would like to sponsor one member of HKODA to attend " Regional Bipolar Disorder & Schizophrenzia Symposium" from 1st to 2nd September 2012, in Phuket, Thailand. Our sponsorship will cover Registration fee, Air ticket and Accommodation during symposium period for the nominated delegate . Interested applicant please fill in the application form below and fax to 3747 9862 or Email to “ momokoyu@yahoo.com.hk ”, Exco of HKODA.
Application form for Sponsorship of “Regional Bipolar Disorder & Schizophrenzia Symposium" September 1st-2nd 2012, in Phuket, Thailand.
Name:
Membership Number : ______
1. Sponsored through HKODA with last
36 months ○
24 months ○
12 months ○
Never ○
2. Active contribution in the association. If yes, please specify
3. Specialty professional qualification ____________________________________
4. Experience relevant to criteria. If yes, please specify
5. Academic presentation at the conference. If yes, please specify
