Application for Scholarship / Sponsorship for 17th APCCMI        
EVENT: 17th APCCMI (Asia Pacific Congress of Clinical Microbiology & Infection) CUM 8th IICC (International Infection Control Conference) 30 August -2 September 2018, Hong Kong  http://www.apccmi-iicc2018.hk 

WHO'S ELIGIBLE: Active HKICNA membership (Ordinary/Associate) for 3 or more years consecutively as of December  2017 and a fully paid-up membership for 2018 upon application .

READ THROUGHLY the regulation and guidance and enter the form
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Type of support for application *
Name of applicant　(Mr./Mrs./Miss) *
Membership Category *
Year joining HKICNA *
Years of Membership *
Years of experience at ICT *
Hospital *
Department *
Position *
Telephone *
Mobile *
Email *
Correspondence Address *
Infection Control Link Nurse ( ICLN) *
Years of ICLN *
Previous ( latest ) voluntary work / contribution to HKICNA　（Year／Type of work） *
Previous sponsorship / scholarship from HKICNA to attend course/ conference *
Name of the latest sponsorship／scholarship *
Year sponsored *
Applying for Scholarship, enter: Title of poster/oral presentation to be submitted *
Applying for Sponsorship, opt either below to contribute to HKICNA if application is successful *
I DECLARE that all the above information provided 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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