Registration Form
Merck Serono

Asia Pacific
Fertility Training
24-27 February 2009 (updated dates)
Hong Kong

01 delegate name

Title (Mr/Mrs/Ms/Dr):
Family Name:
First Name:
Email:
Contact No. (+XXX-XXX-XXXXXXXX): + - -

02  travel documents

Passport No.:
Nationality:
Date of Birth (DD/MM/YY):

03  flight details

Arrival Date (DD/MM/YY):
Arrival Flight: ETA (00:00 24-hr format):
Departure Date (DD/MM/YY):
Departure Flight: ETD (00:00 24-hr format):

04  hotel limousine service

Mercedes-Benz S350 Limo Rate: HK $690/way + 10% service charge
Not Required Airport to Hotel Hotel to Airport

05  room requirements

Room Rate: HK $2,150/night + 10% service charge
Deluxe Peak View Single
Deluxe Peak View Double
Daily Breakfast @ additional HK $250/day + 10% service charge

*please note, light snacks will be served prior to meetings.

special requests
Smoking Non-smoking


Other Requests:

06  deposit / payment guarantee
 (Must complete the following information to secure your reservation)

Credit Card Bank Draft (one-night room rental, non-refundable)

Credit Card Type:
Credit Card No.: Expiry Date: /
Credit Card Holder Print Name:

*Any cancellation made after 02 February, 2009, amendment in terms of late arrival, early departure or no show will result in a cancellation charge of one night room rental for each room night released and will be billed to the credit card number given

07  dietary preferences

Please indicate your dietary preferences / restrictions:

08  clothing size

Please Choose a Size for your T-Shirt:

09  any remarks?