| First Name (required)* |
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| Last Name (required)* |
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| 中文姓名 |
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| Email (required)* |
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| Membership type (required)* |
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| Gender (required)* |
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| Mobile phone no. (required)* |
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| Institution / Hospital (required)* |
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| Position / Job title (required)* |
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| HK Nursing Council Registered / Enrolled number (required)* |
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| Name of the Hospice / Palliative Nursing Specialty course and year of attainment (Ordinary Member only) |
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| Remark |
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| Captcha* |
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