Application Form

Registration Form ANHSS 2024

A Policy Course on Health System Transformation: Private Sector Engagement for a Primary Care-Led Integrated Health Care System
Category*

IndividualGroup
Total Member group*
Individual Package*

USD 250 (early bird)USD 300 (regular)
Group Package*

USD 200 (early bird)USD 250 (regular)
Total Price
Name Members of the Group*
Title*
Gender*

MaleFemale
Name*

First NameLast Name
Name in Chinese

If applicable
Address*
Telp
Mobile*
Fax
E-mail*
example@example.com

Education:*

Professional Qualifications:

	Professional Qualifications	Awarding Institution/Country	Date of Award
1
2
3

WorkingExperience:

Fee Categories

Upload Proof of Payment*

Cancelof
Approval

I declare that the information given in support of this application is accurate and complete, and understand that anymisrepresentation will result in the disqualification of my application for admission.
Payment Information

Account Holder Name : Asia Pacific Network For Health Systems Strengthening Limited
Address : 2/F, School of Public Health Building, 30-32 Ngan Shing Street Prince of Wales Hospital, Shatin, New Territories, Hong Kong
Account Number: 44719019993 (USD SAVINGS A/C)
Bank Name : Standard Chartered Bank (Hong Kong) Limited
Bank Address : Payment Centre, 15/F Standard Chartered Tower388 Kwun Tong Road, Hong Kong
Swift Code: SCBLHKHHXXX

Remarks:
• The registration fee, once paid, is non-refundable or non-transferable.
• Acceptance of application is subject to availability.
• Group discount will only be offered to country team of 4 persons or more, registering at the same time with full payment
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