3-Day Workshop Form

1. Personal Information

Gender

Female
Male

Name in English (The name will be printed on the certificate):

Contact No (Office)

Email

Name in Chinese

Contact No (Mobile)

Correspondence Address

Would you like to receive our courses information by email?

Yes
No

Working Organization

Position

2. Academic Background

Year of Study*

From

To

Name of College / University

Qualification Obtained

From

To

Name of College / University

Qualification Obtained

From

To

Name of College / University

Qualification Obtained

3. Professional Membership (If any)

Institute / Board

Title

Are you a registered social worker?

Yes
No

4. General Information (Please read carefully)

Application will be accepted on first come first served basis until quota is full. Application will only be secured with payment.

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Confirmation will be emailed to registrants within 5 working days of application. (If you do not receive our confirmation, please contact us on 2868 3870).

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The program fee is nonrefundable except that the program is cancelled by our Institute.

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This program is complied with Our Policy on the arrangement of Typhoon and Rainstorm Signal. (Please refer to our Website at https://icthk.org/wp-content/uploads/2024/09/adverse_weather_arrangement_tc.pdf )

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For further enquiry, please send email to kateicthk@gmail.com or contact Miss Chan at 2868 3870

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Declaration

I declare all personal data and information given in this application form are true and correct.

Membership Application

I argee to use the above information for membership application.

5. Payment

Please transfer to the following account via Internet Banking or ATM and upload the screenshot:

Bank Name: HSBC

Account Name: Institute of Cognitive Therapy / I*S OC** LT*AI **T

Account Number: 400 879 300 838 (HKD Saving account)

Amount: HKD 3,740

Upload the bank transfer screenshot:

Click or drag a file to this area to upload.