Paediatric ECG Workshop 2015
Hong Kong Society of Paediatric Cardiology(HKSPC)
PLEASE COMPLETE THIS FORM IN BLOCK LETTERS.
First name:________________________
Last name _________________________
Profession: Dr/Nurse/Allied health
Institution/Private Practice:________________________________________________________________________
Address:________________________________________________________________________________________
Phone:_____________________________________________
Email:______________________________________________
(For those non-members joining the ECG workshop only, please indicate if you would / would not like to receive future
email news from our Society)
Please circle appropriate boxes and fill in details:
categories
Cheque no. and Bank name if
applicable
Existing paid up Member
( 2014-15)
Free of charge
-----------
Existing paid up Associate Member ( 2014-15 )
Free of charge
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Join as new Member
$200
Join as new Associate Member
$100
ECG workshop only *
$500
Please send completed Registration form +/- HKSPC membership application form to info@paedcardiology-hk.org
Membership Application form of HKSPC available at website: www.paedcardiology-hk.org
Please send crossed cheque payable to “the Hong Kong Society of Paediatric Cardiology Limited “to
Dr Chan Kwok Chiu
Department of Paediatrics & Adolescent Medicine
Alice Ho Miu Ling Nethersole Hospital
11, Chuen On Road
Tai Po,
N.T.
Notes:
Registration will be on a first-come-first-serve basis
Registration will only be complete if properly completed form (including membership form if applicable) is received and
cheque (if applicable ) is encashed.
Successful applicant will be informed via email.
Lunch and tea are included in the registration fee