Course Application

Please complete the Application Form

* Compulsory fields
Course Information
Course Name: [The course is full. Next enrollment:
19 January 2022 (Wed) 10:00am will start the next CCNC20 (April 2022) registration.]
19th Critical Care Nephrology Course for Health Care Professionals (CCNC19)
Course Date: 19 Nov 2021, 0830-1700 (Lecture) or and 23 Nov 2021, 0830-1200 (Workshop)
Course Venue: Lecture Theatre, G/F, HKEC Training Centre for Healthcare Management & Clinical Technology,
Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, HK
Personal Details
*Surname: (as appeared on Passport / Identity Card)  
*Given names: (as appeared on Passport / Identity Card)  
*Mailing Address:  
*Email Address: (Confirmation email will be sent to this address)  
Contact Number(s): Office:      *Mobile:  
eLearner ID(HA staff only):  
Career Information
*Position / Rank:  
*Department / Unit:  
*Institute / Hospital:  
I declare that the particulars in this application are true to the best of my knowledge and belief, and I have not wilfully suppressed any material facts.  Any misrepresentation or omission of information will be grounds for withdrawal of acceptance for the application.  I have also read and understood the information about "the Notice to Applicant - Personal Data".
Please note that the above contact details will not be used for unsolicited e-mail or be sold to third parties without the user's consent.