Course Application

Please complete the Application Form

* Compulsory fields
Course Information
Course Name: Hong Kong Gynaecological Endoscopy Society(HKGES) vNOTES workshop
Course Date: 01 Jun 2024
Course Venue: Minimal Access Surgery Training Centre, PYNEH
Personal Details
*Surname: (as appeared on Passport / Identity Card)  
*Given names: (as appeared on Passport / Identity Card)  
*Mailing Address:  
*Email Address: (Confirmation email will be sent to this address)  
Contact Number(s): Office:      *Mobile:  
eLearner ID(HA staff only):  
HKAM Reg. No.:  
Career Information
*Position / Rank:  
*Department / Unit:  
*Institute / Hospital:  
I declare that the particulars in this application are true to the best of my knowledge and belief, and I have not wilfully suppressed any material facts.  Any misrepresentation or omission of information will be grounds for withdrawal of acceptance for the application.  I have also read and understood the information about "the Notice to Applicant - Personal Data".
Please note that the above contact details will not be used for unsolicited e-mail or be sold to third parties without the user's consent.