Application for sponsorship for conference purpose

Download Paper Form

Conference / Course *

Duration with dates *

Venue *

Role in Conference / Course *

Reasons for Attendance *

Name *

Rank *

Department *

Hospital *

Mobile *

Email *

(a) Total number of conference / meeting attended in the last 12 months *

Date attended *

Venue attended *

Name of Conference *

Sponsored by *

Amount *

I agree to follow the terms and submit a report within one month from my return to Hong Kong. *

I agree that no liability should be carried by this association for loss or bodily injury during the meeting or travel. *

I declare that the information provided is true to the best of my knowledge. *

Signature (type full name) *

Designation *

Name *

Date *

Supporting Document (optional; PDF, JPEG, PNG or WebP; max 5 MB)

Your application is stored securely and emailed to the Society Secretariat at info@coloproctology.org.hk for assessment. Applicant details are not published.