THE HONG KONG COLLEGE OF PATHOLOGISTS APPLICATION FOR CHANGE OF FELLOWSHIP STATUS Please tick "" or fill in the blanks where appropriate. Use separate sheets if space provided is insufficient. Name in Chinese (if any): Title: Dr / Prof / _______ Surname (Last Name): First Name (Other Names): Female Sex: Date of Birth (day/month/year): / / Male Founder Fellow Original Membership Category: Fax Preferred Contact Method: Email Fellow Overseas Fellow Post Telephone No.: Fax No.: Email: ___________________________________________ Correspondence Address: I am applying to change my Fellowship status with The Hong Kong College of Pathologists as follows: Practice status # (see Note 1) Retired / Active * For Founder Fellows only: Place of residence (see Note 2) Overseas / Hong Kong * For Fellows / Overseas Fellows only: Fellowship category (see Note 3) Overseas Fellow / Fellow * # FOUNDER FELLOWS, FELLOWS or OVERSEAS FELLOWS who have retired from all remunerative Specialist practice job / business can apply for retired status with the College. * please delete as appropriate I have read and understood the rights and privileges of my newly selected Fellowship status (above) with the College as per the notes of this application form. I undertake to inform the College as soon as possible whenever there is any change in my Fellowship status. Date:____________________________ Signature:____________________________ Completed application form should be returned to: Registrar of The Hong Kong College of Pathologists, Room 606, 6/F, HKAM Jockey Club Building, 99 Wong Chuk Hang Road, Aberdeen, Hong Kong; or by fax: (852) 2871 8755. Applications to change to retired status for Fellowship of the Hong Kong Academy of Medicine (HKAM) and to discontinue CME/CPD programme should be directly submitted to HKAM. Fellows will be removed from the Specialist Register of The Medical Council of Hong Kong (MCHK) after discontinuing CME/CPD programme. Fellows may also consider voluntary resignation from the Specialist Register by directly writing to MCHK. Notes on using your personal data: The personal data provided in this form will be used by the College solely for the activities relating to the processing of your application and to facilitate communication with you. THE HONG KONG COLLEGE OF PATHOLOGISTS (Incorporated in Hong Kong with limited liability) (Page 1 of 2) Last updated: 21 April 2015 NOTES RIGHTS AND PRIVILEGES OF FELLOWS IN RETIRED STATUS (Endorsed by Council on 1.6.2009) 1. FOUNDER FELLOWS, FELLOWS or OVERSEAS FELLOWS who have applied for retired status with the College and are recorded as such in the College Register have the same rights and privileges as full FOUNDER FELLOWS, FELLOWS or OVERSEAS FELLOWS, respectively except the following: (a) Fellows who have retired can enjoy a reduced annual subscription rate. Please refer to the link for College Fees below. (b) Fellows who have retired are not eligible for new appointment as examiner for College Examination. However, if a Fellow changes his / her status to retired state during the term of appointment as examiner, he / she can complete that appointment term as examiner. (c) Fellows who have retired shall pay up the balance of the normal annual subscription rate if they administer CME/CPD activities via College. Please refer to the link of College Fees below. RIGHTS AND PRIVILEGES OF FOUNDER FELLOWS RESIDING OVERSEAS (Endorsed by Council on 21.4.2015) 2. The rights and privileges of Founder Fellows residing overseas shall be the same as those of full Founder Fellows except the following: (a) Founder Fellows residing overseas can enjoy a reduced annual subscription rate. Please refer to the link for College Fees below. (b) If a Founder Fellow residing overseas has resided in Hong Kong for more than 3 months within one subscription year, he / she shall notify the College to change his / her Fellowship status back to full Founder Fellow status, and full annual subscription rate will apply for that subscription year. RIGHTS AND PRIVILEGES OF OVERSEAS FELLOWS (Endorsed by Council on 21.4.2015) 3. The rights and privileges of Overseas Fellows shall be the same as those of full Fellows except the following: (a) Overseas Fellows can enjoy a reduced annual subscription rate. Please refer to the link for College Fees below. (b) Overseas Fellows do not have voting right in the Annual General Meetings or Extraordinary General Meetings. (c) If an Overseas Fellow has resided in Hong Kong for more than 3 months within one subscription year, he / she shall notify the College to change his / her Fellowship status back to full Fellow status, and full annual subscription rate will apply for that subscription year. Please refer to the College website (http://www.hkcpath.org/Docs/CollegeFees.pdf) for the latest information on annual subscription fees. THE HONG KONG COLLEGE OF PATHOLOGISTS (Incorporated in Hong Kong with limited liability) (Page 2 of 2)