* Login ID / E-mail:

Password: (Minimum of 8 characters)

Retype Password: (Please re-enter your password here)

Title: 
 Mr     Ms     Mrs     Dr     Prof   

Sex: 
 M    F   

Surname: 

First Name: 

Chinese Name (If any): 

I.D. Card No. (first/two letter with 4-digit): 

Hospital / Institution / Office: 
---- Please select -----HA Hospital University Private Others

Occupation: 
---- Please select -----Surgeon Occupational Therapist Physiotherapist Prosthetist & Orthotist Nurse Others

Hospital / University Name: 

Department: 

Type of Membership: 

1. ** Eligible to members who have had 4 continuous years of full membership immediately prior to election as Life Member. After the application is approved, no more membership fee will be collected in the future.
2. ** Please download the pdf application form, fill in all necessary information and send it back to HKSSH together with a cheque of HK$1,500 by mail.

Office Telephone No: 

Mobile Phone No: 

Fax No (Office): 

Correspondence Address: 

Professional Qualification: 

* Proposer: 

* The proposer must be a Life Full Member / Life Associate Member / Full Member of HKSSH
* Prior verbal consent from proposer must be obtained before submission of application form.

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