Membership Application Form
(For renewal of membership, please quote your UNAHK No. and fill in the items that require amendment)
 
New join Member           Renew Member           Student Member            Life Member
  Surname :
  Given Name :
  Chinese Name :
  Rank :
  UNAHK No.(if any) :
  Ward/Hospital :
*Home Address :
  Tel (Home) :
*Mobile :
  Fax :
*E-Mail :
     
I would like to be a Combined Member of EAUN and I agree to disclose my personal information to EAUN for receiving their information.
Yes            No 
     
Membership Fee    
Annual Membership Fee   HK$ 250
Life membership   HK $1,800
     

(Please send the payment to Rm 1101-1104, 11/F, Grand Centre, 8 Humphreys Avenue, Tsimshatsui, Kowloon, Hong Kong by cheque only, Payable to: "Urology Nurses Association of Hong Kong (UNAHK)"

I agreed to submit the above personal information for application.

     
   
Phone : 2191-9994