HONG KONG ACADEMY OF MEDICINE MCHK CME Programme

CME Programme for practising doctors who are not taking CME programme for specialists

Registration Consent Form

I confirm that I would like to register with the Hong Kong Academy of Medicine via the College of Surgeons of Hong Kong as my CME administrator for the above CME programme.

Please also complete the following part if you are currently registered with other Administrators, namely the Department of Health (DH), Hong Kong Doctors Union (HKDU) or Hong Kong Medical Association (HKMA) for the programme (see Note 1).

I am currently registered with DH/HKDU/HKMA* as my CME administrator but would like to choose the Hong Kong Academy of Medicine as my new CME administrator.

* delete as inappropriate

Name: _______________________ (MCHK Registration No: )

Signature: _______________________

Date: _______________________

Notes:

1) Please note that transfer can be arranged normally only after a cycle year has completed.

Microsoft Word - consent form.doc

faipang

2016-03-09

kenli