Course Application

Please complete the Application Form

* Compulsory fields

Course Information

Course Name:

Diabetic Limb Salvage Symposium 2025

Course Date:

13th December 2025, 08:50-17:00

Course Venue:

HKEC Training centre for Healthcare Management & Clinical Technology, Pamela Youde Nethersole Eastern Hospital

Member of Hong Kong for Vascular Surgery:

Yes

No, but can send me the membership application form and information

Remarks:

Personal Details

Title:

Prof.

Dr.

Mr.

Ms.

Mrs.

*Surname:

(as appeared on Passport / Identity Card)

*Given names:

(as appeared on Passport / Identity Card)

*Mailing Address:

*Country:

*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

*Professions:
*Position / Rank:
*Department / Unit:
*Institute / Hospital:

Declaration

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".

I declare that I have read and confirm the above declaration

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.