PERSONAL
PARTICULARS
REGISTRATION
INFORMATION
Fields marked with
*
are mandatory
PERSONAL DETAILS
Title
*
Prof.
Dr.
Mr.
Mrs.
Ms.
First Name
*
Last (Family) Name
*
The name will be used for printing the certificate, please be exact.
CONTACT INFORMATION
Practice Location
Hong Kong
Macau
HKDC no.
Please fill in your Dental Council Registration Number if you are registered in Hong Kong.
Mailing Address
*
Tel
*
country code
Mobile
*
country code
Email Address
*
Email address serves as login username.
Password
*
Re-type Password
*
must be 4-8 digits/characters, password is case-sensitive
Membership
Membership Categories
*
Student Membership (Free)
Affiliate Membership (HKD 200)
Ordinary Membership (HKD 500)
Supporting Document
Please provide supporting document such as photo of your student card.
Marketing opt-out
We intent to use your name, telephone number and correspondence address for direct marketing of HKSED Ltd. or her related activities but we cannot so use your personal data without your consent.
Should you find such use of your personal data no acceptble, please indicate your objection before submitting the appilcation by checking the box below, otherwise we will assumed you agreed with the above proposal:
The customer named objects to the proposed use of his/her personal data in direct marketing of HKSED Ltd. or her related acitivites.
opt-out
