Hong Kong Public Hospital Cardiologists Association Ltd
香 港 公 立 醫 院 心 臟 醫 生 協 會 有 限 公 司
Membership Application Form
English Name:
Chinese Name:
Sex:
Hospital:
□ Full Member (Registered Specialist in □ Associate Member (Higher Physician
Cardiology, Hong Kong)
Trainee in Cardiology, Hong Kong)
Correspondence Address:
Mobile phone no:
Fax no:
Email:
□ Please tick
Signature of applicant: _____________________
Date: ______________________
Proposer: ____________________________
Signature: _______________________
Seconder: ____________________________
Signature:_______________________
Completed application form and entrance fee by a cheque ($300 for full member and $200 for associate member)
made payable to “Hong Kong Public Hospital Cardiologists Association Limited” should be sent to 7/F,
Administration Office, Yan Chai Hospital Multi-services Complex, 18 Yan Chai Street, Tsuen Wan, Attn : Ms.
Wandi LAI, Superintendent. Enquiry on membership should be directed to Ms. Wandi Lai ( wandi@hkphca.hk )
Only full member is eligible to vote in general meeting. Proposer and Seconder shall be full member of
HKPHCA