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Hong Kong Association of Renal Nurses 香港腎科護士學會
Membership Application Form (for new member)
會員入會
申請表格
Name in English (Please write in BLOCK LETTER)
*
Please fill the required field.
Name in Chinese 中文姓名
HKID Card / Passport No (first 4 character) 香港身份證/護照號碼(首4位) :
*
Please fill the required field.
Sex 性別
*
M 男
F 女
Please fill the required field.
Hospital / Organization 醫院名稱/服務機構
*
Please fill the required field.
Department 部門
Rank 職位
Telephone No 通訊電話 (office / Mobile)
*
Please fill the required field.
Email (Please use personal email)
*
Please fill the required field.
Fax No 傳真
Renal Nursing Training Institution 腎科護理院校 :
Currently practising in renal nursing Yes / No
Please tick the membership category 請選擇會員類別
Full Member 基本會員 (Annual Subscriptions HK$100)
Retired Member 退休會員 (Annual Subscriptions HK$50)
Associate Member 附屬會員 (Annual Subscriptions HK$50)
Occupation 職業
Registered Nurse 註册護士
Enrolled Nurse 登記護士
Others 其他
Name of Proposer 推薦人姓名 :
Proposer Telephone Number 推薦人電話
Proposer's Hospital 推薦人工作醫院 :
Date 日期
Please select whether you would allow or not the Council to release your personal correspondence to renal related bodies with purpose of such request approved by the Council. 請選擇以示閣下同意本會於洽當情況下,將閣下之通訊地址交予腎科有關組織作適當用途。
Allow
Do not allow
To complete the application, please press "Send Message" and then go to the "Subscription" page for payment.
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