REGISTRATION FORM
Please complete the form below and return to the
ISN Forefronts Symposium Shenzhen 2015 – Registration Office c/o International Conference Consultants Ltd
Office Address: Unit C-D, 17/F, Max Share Centre, 373 King’s Road, North Point, Hong Kong
Tel: +852 2559 9973
Fax: +852 2547 9528
Email: forefronts@icc.com.hk
PERSONAL DETAILS
(Please type or print in block letters and  where appropriate)
☐ Prof ☐ Dr ☐ Mr
First Name (Given Name):
☐ Mrs
Title:
☐ Ms
☐ Miss
☐Others, please specify:
Family Name (Last Name):
Doctoral-Level Degree(s):
Position:
Institution:
Address: (please check one)
Home address
Work address
Street / Box:
City:
Zip/Postcode:
State/Province:
Office Tel:
Mobile:
(Please include the international and area code in the above numbers.)
Country:
Fax:
Email:
National or specialty Society Affiliation:
Date of Birth (DD/MM/YY):
Male
Female
Do you have any special dietary requirement?
☐ None ☐ Vegetarian ☐ Pork-free ☐ Beef-free ☐ Halal ☐ Please specify if you have food allergy:
___
Do you have any special accessibility needs? If yes, please specify,
Data Privacy: All information requested is strictly for the use of the ISN in compliance with international privacy legislation. By completing, I agree that ISN may
use this data to keep me fully informed of the Forefronts 2015 and ISN activities. By giving consent my mailing address maybe made available to third parties
deemed appropriate by the ISN for the purpose of organizing the Forefronts 2015. If you do not wish to receive third party mailings linked to the organization
of the Forefronts 2015 please check here ☐
AREA OF ACTIVITY
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(please check all that apply)
Administrator
Basic Researcher
Industry Representative
Teacher/Educator
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PROFESSIONAL INTEREST
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Acute Renal Failure
Cell and Molecular Biology
Developmental Biology
Genetics
Immunology
Mineral Metabolism
Pediatric Nephrology
Physiology
Others, please specify:
Allied Health Professionals (Dietitian, Nurse, Pharmacist, Technician)
Clinical Practitioner
☐ Clinical Researcher
Retired
☐ Student
Others, please specify:
___________________
(please check all that apply)
☐ Anemia
☐ Chronic Renal Failure
☐ Diabetes
☐ Hemofiltration
☐ Interventional/Critical Care Nephrology
☐ Nephrolithiasis
☐ Peritoneal Dialysis
☐ Transplantation
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PRIMARY PRACTICE SETTINGS
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Company
Group Practice
Teaching Hospital
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Biostatistics
Clinical Nephrology
Dialysis
Hypertension
Membrane Transport
Pathology
Pharmacology
Urology
(please check all that apply)
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Dialysis Clinic
Individual Practice
Others, please specify:
☐ Government Hospital
☐ Private Hospital
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REGISTRATION FEES
Please refer to the website at http://www.isnforefronts.org/shenzhen/registration-home for Registration entitlement.
Early Bird Rate
Regular Rate
Registration Category
(on or before July 24, 2015)
(after July 24, 2015)
ISN Members (1)
ISN Membership Number:
☐ US$605 (HK$4,720)
☐ US$735 (HK$5,730)
New ISN Members Joining (2)
☐ US$775 (HK$6,040)
☐ US$905 (HK$7,050)
Non-Members (3)
☐ US$735 (HK$5,730)
☐ US$870 (HK$6,780)
Note: The rate in USD is for reference only. All registration should be made in Hong Kong Dollar (HK$).
* Please indicate your membership number when registering for ISN Forefronts Symposium Shenzhen 2015 in order to receive
the ISN Member registration rate.
Description of Membership Types and Registration Categories
(1) ISN Members: Members in good standing of the ISN
(2) New ISN Members Joining: Individuals currently not a member of the ISN who wish to attend the symposium and join ISN as a
member at the same time (significant savings)
(3) Non Members: Individuals registering to the Symposium but not interested in being ISN members
LETTER OF INVITATION / VISA APPLICATION
Most foreign nationals require a visa to enter Mainland China. Visas should be obtained from the Embassy or Consulate
General of the People's Republic of China in the applicant’s country before departing to Mainland China. Information can
be found from the website at https://www.ctshk.com/english/useful/chinesevisa.htm.
If your departure flight is in Hong Kong and you are from countries for which visas are required for entry to Hong Kong,
please note that you will have to apply for 1 visa to China and 2 visas to Hong Kong.
The ISN Forefronts Symposium Shenzhen 2015 – Registration Office will send a letter of invitation by email to participant
to attend the Symposium. Such an invitation is extended specially to assist participants to obtain travel refunds,
appropriate visas, approvals, sponsorship or leave. The letter will be issued only after the payment has been received. It
does not imply a commitment on the part of the Organizer to provide any support, financial or otherwise.
☐ Please send me a letter of invitation.
HOTEL ACCOMMODATION
☐ Please check the box if you would like to make reservation at the Four Points by Sheraton Shenzhen and receive the
Hotel Booking Form.
PAYMENT
I hereby agree to be bound by the rules and regulations of the Symposium and would like to settle the payment of
HK$___
________ by
☐ Credit Card (in Hong Kong dollars only): Visa or MasterCard
(Please contact your credit card company to notify them of this international charge to prevent the transaction from
being rejected. The merchant name shown on the statement will be ICC LTD and the amount charged will be in HKD.)
Credit Card Number:
Cardholder’s Name:
☐
Expiry Date:
Cardholder’s Signature:
Bank Transfer
Please contact the ISN Forefronts Symposium Shenzhen 2015 – Registration Office at forefronts@icc.com.hk if you
wish to pay by bank transfer. Deadline for payment by bank transfer is September 15, 2015.
REPLACEMENTS AND CANCELLATION POLICIES
Cancellations of confirmed registrations are subject to an administrative charge of 150 USD provided the cancellation is received
before September 11, 2015. For cancellations received after this date no refunds will be made. All cancellations must be made
in writing to ISN Forefronts Symposium Shenzhen 2015 – Registration Office and refunds will be made after the Symposium.
Replacements (=delegate name change) of a confirmed registration may be made on or before August 14, 2015 free of charge.
After this date, no replacement can be made.
Please refer to the website at http://www.isnforefronts.org/shenzhen/registration-home for detailed Terms and Conditions.