HKU-Pasteur Research Centre Limited

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HKU-Pasteur Research Centre Limited
International Association of Gerontology and Geriatrics (IAGG) Master Class on Ageing
Theme: Intensive Training on Ageing and Geriatric Medicine
29 – 31 August 2012
Hong Kong SAR, China
Co-organized by:
International Association of
Gerontology and Geriatrics
(IAGG)
The University of Hong Kong
Li Ka Shing Faculty of Medicine
Research Centre of Heart, Brain,
Hormone & Healthy Aging
The Hong Kong Geriatrics Society
COURSE APPLICATION FORM
Please read the following notes before competing this form:
1. Basic admission requirements include: Medical Practitioner with Bachelor Degree in Medicine
2. Applicants are advised to provide all the information requested in the form, where applicable,
failing reaching the Course Provider may not be able to process and consider your application.
3. Please send the completed form together with the updated Curriculum vitae (CV) by e-mail to
[email protected] to the Course Secretariat, Research Centre of Heart, Brain, Hormone & Healthy
Aging on or before 7 July 2012
4. Please submit an abstract for poster presentation.
5. FREE registration and an official acceptance letter of admission will be provided to every
successful applicant.
1. PERSONAL INFORMATION:
Surname:
Given name (in full):
Nationality:
Correspondence
Address:
Contact phone no:
Email address:
2. YOUR CURRENT POSITION:
Institute:
Department:
Country:
Current Position &
Specialty:
Start Date:
1
3. ACADEMIC QUALIFICATIONS: (most recent first)
i.
Title of Degree:
Year Obtained:
Major Subject:
Institution:
Country:
ii. Title of Degree:
Year Obtained:
Major Subject:
Institution:
Country:
4. DETAILS OF YOUR CURRENT SUPERVISOR
Surname:
Department
Institution:
Given name (in full):
&
Position:
Correspondence
Address:
Contact telephone no:
Email address:
5. SUBMISSION OF ABSTRACT FOR POSTER PRESENTATIONS
Instructions and Format for Abstracts:
(a)
(b)
(c)
(d)
(e)
(f)
All applicants for the (IAGG) Master Class on Ageing are required to submit an abstract
for poster presentation in MS Word format with the abstract form below to the Course
Secretariat by 7 July 2012 via email at [email protected]
All abstracts must be written in English within an A4 page and set in Times New Roman with
no less than 10 points in font size.
The title of the abstract should be typed in Capital Letters. Authorship: initials followed by
family name, and underline the presenting author (please also list the address(es) / institution(s)
of the authors).
The objectives, methods, results and conclusions should be described. One figure or table may
be included, though at the expense of the total number of words.
Confirmation of acceptance of abstracts will be communicated to the Presenting Author by 20
July 2012. The exact schedule of presentations at the Course will be communicated to the
Presenting Author by 17 August 2012.
In addition, applicants are required to prepare their abstract for poster display and presentation
at the designated sessions during the course once their abstracts are accepted. All posters must
be affixed on the assigned display unit measuring 990mm (H) x 690mm (W) before 13:00 on
29 August 2012 and removed by 31 August 2012.
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ABSTRACT FORM
Topics:
Title:
1. Biology of ageing
and longevity
2. Demography and
epidemiology of
Ageing
Authors and Institutions
3. Falls
4. Dementia and
cognitive
impairment
Content of the abstract
5. Stroke
6. Parkinsonism and
Gait disorder
7. Metabolic,
endocrine and
nutritional
disorders
8. Sarcopenia and
Frailty
9. Continence
10. Cardiovascular
disorders
11. Rehabilitation
12. Palliative and endof-life care
13. Nursing home care
14. Community home
care
15. Others
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6. DECLARATION AND SIGNATURE
I declare that the information I have given in this application is correct and complete to the best of
my knowledge and belief. I agree that the course organizer may conduct a reference check by
contacting my present supervisor(s) and or institution(s).
Signature:
Date: __________________________
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