香港醫務化驗師協會
Hong Kong Biomedical Scientists Association
Membership Application Form
New member
Membership renew (member no._______________ )
Name (English) :_____________________________ (Chinese) :___________________________
Hospital
Sex :_____HKID : □ □ □ □ XXX(X) /Institution/Company :_________________________
Lab. /
Post/
Specialty :______________________ Rank : ______________
MLT Board
Reg. No. :_______________
Mailing Address : _________________________________________________________________
________________________________________________________________________________
Contact phone No.: ____________________E-mail : _____________________________________
Date: ________________
Signature:__________________________
Please complete all the fields above
Notes for application
1.
For new membership application, please submit copy of “HA staff ID card” or “Annual Practicing Certificate”
issued by Supplementary Medical Professions Council of Hong Kong.
2.
Existing members are also required to complete the membership form to renew membership.
3.
Application fee for new member is $10, no application fee for membership renewal.
4.
Annual Subscription: $60 for one year; $100 for two years.
5.
Payment method:

By cheque --- please make cheque payable to “Hong Kong Biomedical Scientists Association”.

By bank payment --- HSBC account 008-3-070177 (Hong Kong Biomedical Scientists Association),
please Whatsapp the copy of receipt / customer advice to 9547 2835 (Franco Tsang).
6.
Submit application:

By mail (all payment methods) --- send all necessary documents to “Franco Tsang, Blood Bank, 3/F
Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, N.T.

By fax (not suitable for cheque payment) --- fax all necessary documents to 3016 9497
7.
The collection of personal data is for domestic registration and communication purposes only.
8.
For enquiry --- Website : www.hkbsa.org.hk
E-mail : info@hkbsa.org.hk
Fax : 3016 9497
Contact: Blood Bank, 3/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, N.T.
--------------------------------------------------------------------------For office use only-----------------------------------------------------------Received on :______________Approved on :_______________ Recorded by :________________________
Remarks:__________________________________________ Membership No:________________________
Ver. 2017_01