The Dental Council of Hong Kong Continuing Professional Development (cpd) Programme for Practicing Dentists Enrollment Form



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The Dental Council of Hong Kong

Continuing Professional Development (CPD) Programme for Practicing Dentists

Enrollment Form (Cycle 1-1-2011 to 31-12-2013)


Name in English:













(Surname)

(First Name)

Name in Chinese:







Dental Council Registration Number:







Date of first registration with Dental Council:




HKDA Member:

Yes □ No □

HKDA Membership Number:

(If Applicable)

Correspondence Address:




Contact Number:

Office:




Mobile:




Fax Number:







Email:






Please select only one of the following Administrators (put a “” in the box provided):




Administrators










Department of Health (DH)

Tel: 2961 8798 Fax: 2573 0518



Remarks: Applicable for Government Dental Officers only. No fee required.






















Hong Kong Dental Association (HKDA)

Tel: 2528 5327 Fax: 2529 0755



Remarks: Enrollment fee for HKDA members is HK$500 and for non-members is HK$1,500 for the whole cycle of 3 years (2011-2013). Please complete this form and enclose a cheque of the right amount payable to “Hong Kong Dental Association Ltd” and send to HKDA, 8/F, Duke of Windsor Social Services Building, 15 Hennessy Road, Wanchai, HK.






















The College of Dental Surgeons of Hong Kong (CDSHK)

Tel: 2871 8866 Fax: 2873 6731



Remarks: Enrollment fee is HK$1,000 for the whole cycle of 3 years (2011-2013). HK$2,000 will be charged as administrative fee if application is received after 30 June 2012. Cheque made payable to “The College of Dental Surgeons of Hong Kong” should accompany this Form and send to CDSHK, Rm 902, HKAM Jockey Club Bldg., 99 Wong Chuk Hang Rd., Aberdeen, HK.













Please complete and mail this enrollment form with a crossed cheque to the selected administrator.










(Signature of Enrollee)




(Date)


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