Personal Particulars

Salutation^*

Mr
Mrs
Ms
Miss

Name in Chinese^*

Full name in English (The Name of applicant must be consistent to the name that will be printed on the certificate of Attendance)^*

Gender^*

Male
Female

Company / Organisation^*

Occupation^*

Position^*

Correspondence address^*

Mobile No.^*

Email address^*

Expectation of the Workshop

Please write down your expectation for this course:

Others

Where did you get the information about this course? (You may choose more than one answer)

Others

Important Notes

The personal data provided in the application form for programme admission will be used for the purpose of processing application, administration, and statistics.
Your application will not be considered if you fail to provide all necessary information as requested.

Personal Information Collection Statements

Statement #1

The personal data provided by means of this form will be used by our Project for the purpose of your registration/application, administration, and statistical analysis.

Statement #2

I do not wish our Project to use my personal data (including name, job title, telephone number, postal address and email address) to promote education and training programmes.

The above represents your present choice whether or not to receive promotional materials. This replaces any choice communicated by you to our Project prior to this application. You may, at any time, choose not to receive any course promotion by emailing us to cancersupport@hkacs.org.hk.

Declaration

Declaration^*

I declare declare that all information provided in this enrolment form is, to the best of my knowledge, accurate and complete. 2. I have noted, understood and agreed all terms and conditions of this form.

Capacity building for Professionals

Personal Particulars

Expectation of the Workshop

Others

Important Notes

Personal Information Collection Statements

Declaration