Hong Kong Association of Rehabilitation Medicine (Hong Kong, China)

香港康 復醫學學會

Membership Application / Renewal Form Name:

__________________(中文)

Sex:

M/F

Please “” as appropriate:  New Membership Application  Membership Renewal (Only need to fill in the following if there is change in information) Organization: _______________________________

Post: _________________________

Corresponding Address: _____________________________________________________________________________ E-mail Address:|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_| Contact Telephone No.: |_|_|_|_|_|_|_|_| Professional Qualifications:

Type of membership applying or to be renewed:  Full member (HK$400 per year for combined HKARM / ISPRM annual subscription) - Medical practitioners registrable and practising in clinical rehabilitation services in HK.  Associate member (HK$200 per year) - Medical practitioners registrable in HK & practising in other fields or allied disciplines or nurses registrable in HK, who show an active interest in rehabilitation medicine.  Life member (HK$2,000) - Elected from full members who have paid the life membership subscription. (N.B. Annual membership subscription expires at 31 Dec of each year.) Applicant’s Signature: ______________

Date: ______________ Cheque No.: _____________

For new applicant, nominated by (current Full Member): __________________________________ Please enclose the crossed cheque payable to “Hong Kong Association of Rehabilitation Medicine” and send to the following address. ----------------------------------------------------------------------------------------------------------------------------Attn.: Dr. Eric Yeung (Honorary Treasurer, Hong Kong Association of Rehabilitation Medicine) Department of Rehabilitation M/F, Kowloon Hospital Rehabilitation Building, 147A Argyle Street, Kowloon.

Membership Application Form 2017.pdf

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