Visit Request Form

I.Proposed Date of Visit
Date (DD/MM/YY) * ：
Start Time * ：		End Time * ：
II.List of Delegation
Please provide the Name, Department / Office, Position * ：
III. Contact Person
Title * ：
First Name * ：		Last Name * ：
Name of Institution/Organization * ：
Email * ：
Tel * ：		Fax ：
Accommodation in Hong Kong (if any) ：
Contact Tel in Hong Kong (if any) ：
IV. Details of Visit Request
Purpose of Visit [No more than 100 words] * ：
Specific Areas / Topics of Interest for Discussion [No more than 100 words] ：
Do you wish to receive a campus tour?		Yes No
Is there anyone specific at CityU whom the delegation would like to meet?		Yes No
If yes, please provide their Name, CityU Department / Office and Position ：
* Field Required

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