Young Nephrology Investigators Scholarship Application Form
Young Nephrology Investigators Scholarship Application Form
Name of Applicant: _____________________________ Title: ___________________
Date of birth: ________________
Unit and Institution: _____________________________________________________
Address: ____________________________________________________________
Telephone: __________________________ Fax: ____________________________
Meeting to be attended: ________________________________________________
Organization of the Meeting: _____________________________________________
Title of the Abstract: ___________________________________________________
___________________________________________________________________
Authors of the Abstract: ________________________________________________
__________________________________________________________________
Status of the applicant:
Nephrology trainee / Fellow (Medical Officer, Resident, Resident Specialist) /
Nurse / Medical Technologist / Scientist / Allied Health Professional
Status of membership: Full / Associate
Declaration by the applicant:
I declare that I will not receive any other sponsorship for this meeting if my
application is successful.
Signature of Applicant:
______________________________ Date: ________________________
Certification by the head of the Division of Nephrology:
I declare that the above applicant is a Trainee / Fellow / Nurse / M.T. /
Scientist / Allied Health Professional * aged 40 or below on the first day of
the meeting, and I support his/her* application.
___________________________________ Date: ________________________
(Signature) / (Block letters)
Please submit a copy of the abstract and the letter of abstract acceptance to
Dr Desmond Yap, Membership Affairs, HKSN by email: desmondy@hku.hk, fax: 2872 8828, or
mail c/o: Department of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
*Delete where appropriate
(For Official Use)
Application Result: Approved / Not Approved. Approved amount: HK$___________