Membership Application

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)

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)

Life Member 終身會員 (Annual Subscriptions HK$0)

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

Email

Membership Application Form

Hong Kong Association of Renal Nurses 香港腎科護士學會

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