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Membership Application Form
Please fill in the form, print out the form and send to Kowloon Central Post Office PO Box 72958 with cheque payable to Hong Kong Enterostomal Therapists Association.
HKETA No. (if any):
Chinese Name:
*Surname:		Mr Ms Mrs
*Given Name:
Date of birth:		year month day
Travel Document / ID:
*Mailing Address:
Work place:
Post:
*Correspondence send to :		Home Office

*Tel (Home):
Tel (Office):
Fax (Home):
Fax (Office):
Pager:
Mobile:
E-mail:

Basic Nursing Training
Nursing School:
year qualified:

Enterostomal Therapy Training
Name of ET School:
Year Qualified:
City / Country (if not HK):

Type of membership (please tick one)
Life membership HK$1200		Any full member who pay up a sum of subscription specified in the application form, he/she shall not required to pay annual subscription thereafter.
Full membership HK$180 (Per annum)		Any qualified nurse who have had taken a Enterostomal Therapist course which is recognised by international organisations (e.g. WCET/ WOCN).
Associated membership HK$60 (Per annum)		Any qualified nurses or nurse trainee who interested in enterostomal therapy.
Affiliated membership HK$120 (Per annum)		Any medical or paramedical staff who interested in enterostomal therapy.

Entrance fee HK$100 (for new member only)		New member
*Membership fee:
Total amount:		HK$