MEMBERSHIP APPLICATION FORM
INFORMATION
Title:
*
Mr
Ms
Mrs
Prof
Dr
Surname:
*
Given Name:
*
Chinese Name
(If any)
:
E-mail:
*
Contact No:
*
Fax No (Office):
Post:
Qualification:
Hospital/Institution:
*
Field of Interest in Cytology:
Nomination:
The applicant must be nominated and seconded by Medical or Non-medical members of the Society. Both of them will attest to your character and professional standards.
Medical / Non-medical Member 1 Email:
*
Medical / Non-medical Member 2 Email:
*
Personal Data
The personal data so provided are mainly for the use within the Society but they may also be disclosed to other relevant parties for the purposes mentioned in the objects above. Apart from this, the data may only be disclosed to parties where you have given consent to such disclosure or where such disclosure is allowed under the Personal Data (Privacy) Ordinance.
Subscription
The entrance fee to the Society shall be HK$200.00
The annual membership fee of the Society for Medical members, Non-medical members and Associate members is HK$200.00
I have read and agreed to the important notes set out on this form.
