3-Day Workshop Form

1. Personal Information

Name in English

Contact No (Office)

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

You could transfer the fee to our bank account. The bank detail is as shown below:
Bank Name: HSBC
Bank Account Name: Institute of Cognitive Therapy /
I*S OC** LT*AI **T
Bank Account Number: 400 879 300 838
Amount: HKD 3,740

Payment Receipt

Click or drag files to this area to upload. You can upload up to 5 files.