Course Application
  Course Name :
  Course No. :
 
  Surname :
  Given Name :
  Chinese Name :
  Rank :
  UNAHK No.(if any) :
  Ward/Hospital :
*Home Address :
  Tel (Home) :
*Mobile :
  Fax :
*E-Mail :
     
(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 Nurse Association of Hong Kong (UNAHK)"

I agreed to submit the above personal information for application.
     
   
Phone : 2191-9994