The Hong Kong Medical Association
Health Education Programme
Volunteer Registration Form
To : Health Education Committee
The Hong Kong Medical Association
5/F., Duke of Windsor Social Services Building
15 Hennessy Road, Wanchai, Hong Kong.
(Facsimile no. : 2865 0943; E-mail address : hkma@hkma.org)
Name
Membership No.
Address
E-mail Address
Phone no. (Office)
Fax no.
Specialty
Sub-specialty (if any)
Qualifications
Previous Experience of Contact with Media :
Previous Experience of Public Health Talk :
Please “” as appropriate.
I wish to participate in the following programmes :
□ Television
□ Contribution to articles in newspapers and magazines
□ Radio & Press Enquiries
□ Lectures
□
□
I am prepared to answer any question on any subject.
I am prepared to answer any question on my specialty.
Signature
Date