Specialist Training Registration Form

THE COLLEGE OF DENTAL SURGEONS OF HONG KONG
Specialist Training Registration Form
Registration for: Basic Training
Higher Training
(Please tick one)
Photo
Specialty:
Name:
Name in Chinese:
Nationality: Sex: M/F* Date of Birth:
HKID Card/Passport No.:
Address:
Address for Correspondence (if different from above)
Tel No.: (Home)
Fax No.:
(Office)
E-mail Address:
Basic Qualification (with date):
Higher Qualification (with date):
Registration with the Hong Kong Dental Council Yes/No*
If yes, please state the year .
Number of Years in Supervised Training
(Details Overleaf)
* Please delete if not applicable
Signed:
Date:
Please enclose the following documentation:
1 certified copy of all your certificates;
2 a copy of your registration certificate; and
3 documented evidence of your training;
and return these to the Secretary of the respective specialty board.

Details of Supervised Training
Institution From To No of Years
(full time
equivalent)
Documented evidence, from the relevant training institution, must accompany this
form
For Office Use:
Approved
Not Approved
Comments:
Signature of
Chairperson of
Specialty board
Date:
Signature of
Secretary of
Specialty board
Date:
Name of Trainer: