Application for Scholarship / Sponsorship
Event for Application: 9th APSIC on 19-22 March 2019, Da Nang, Vietnam
Deadline for Application: 31 October 2018
Eligible to Apply: Upon application, active HKICNA membership for 3 or more years consecutively as of December 2017 and a fully paid-up membership for 2018.
Note# Successful sponsorship applicant is required to commit two contributions: # 1. 2019 IC Course (Sept - Nov) Site helper of 1 session (5:30pm -7pm) # 2. Booth helper for promotion of 9th IICC at APSIC 2019 in Vietnam
1.Type of support and membership required *
2.Title of poster / oral presentation to be submitted *
3.Name of applicant (Mr./ Mrs./ Miss) (Surname) (Other Name) *
4.Name of applicant (Chinese) *
5.HKID No. (First English Letter + 4 digits) *
6.Membership Category *
7.Year joining HKICNA *
8.Years of experience at ICT *
9.Current Infection Control Link Nurse (ICLN) *
10.Current working place (Hospital) *
11.Department/Unit *
12.Rank *
13.Telephone *
14.Mobile *
15.Email *
16.Correspondance Address *
17.Previous sponsorship / scholarship from HKICNA *
18.Name the latest sponsorship and the year sponsored
Declaration: I DECLARE that all the above information submitted by me are true and correct and I further understand that any dishonesty or false representation on this application form will lead to disqualification.
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