Hong Kong Association of Rehabilitation Medicine (Hong Kong, China)

香港康 復醫學學會

Sponsorship Application Form Applicant’s Name: Surname

_________________(中文) First name

Organization: __________________________________

Sex:

M/F

Post: __________________________

Corresponding Address: _______________________________________________________________________________ _______________________________________________________________________________ E-mail Address: _________________________ Type of HKARM member:

 Life member

Contact Telephone No.: __________________  Full member

 Associate member

Name of Meeting: _______________________________________________________________ Date of meeting: ___________________________

Place: _____________________________

Participation in the meeting:  Chairman  Invited speaker  Oral presentation  Poster presentation  Passive attendance Previous contribution to Rehab specialty or HKARM: ____________________________________ If I am selected to receive the sponsorship, I understand and agree that:  Reimbursement will only proceed after the sponsor amount is duly received from the sponsoring commercial company.  I will immediately notify HKARM if I cannot attend or finally have not attended the meeting.  The sponsorship is not transferable to other person. It should be the decision of HKARM council.  All expenses exceeding the sponsor amount will be borne by the applicant.  I cannot accept other sponsorship or top-ups for the same event.  A copy of the Certificate of Attendance will be sent to HKARM after the meeting. If you are unable to provide Certificate of Attendance and/or official receipts, please explain the reason(s) in the “Reimbursement Without Proof” form and the ultimate decision of reimbursement will be subjected to the final approval of the Council of HKARM.  (For HA staff) I will approach my cluster HRD for the HA rules & regulations on accepting external sponsor.  I may be invited and I agree to present “What is learnt from the meeting” in the Inter-Hospital Rehabilitation Meeting.

Applicant’s Signature: _________________________ Date: _________________ An administration fee of HK$200 in cheque made payable to the “Hong Kong Association of Rehabilitation Medicine” should attached with the application form and is non-refundable. Please send this form and the cheque to the following address: ----------------------------------------------------------------------------------------------------------------------------Attn.: Dr. CHU Chun Kwok, Angus (Honorary Secretary, Hong Kong Association of Rehabilitation Medicine) Room 9.029, 9/F, Rehab Block, Tuen Mun Hospital, N.T.