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Dept. of Surgery
2/F Professorial Block
Queen Mary Hospital
Pokfulam, Hong Kong
Phone: (852) 2855 4235
Fax: (852) 2818 1186
E-mail: isds@hku.hk

Founded as the Collegium Internationale Chirugiae Digestivae

Membership Application

General informations

Name:

Address:

City:

State:

Zip Code:

Country:

E-mail:

Phone (Home):

Phone (Work):

Date of birth:
(If you are less than 40 years of age and wish to claim the reduced dues available to young surgeons, send a copy of your birth certificate, passport or other similar documentation)

Nationality:

Medical Schools

Medical School 1:

Date attended 1:

Degree(s), Year Awarded 1:

Medical School 2:

Date attended 2:

Degree(s), Year Awarded 2:

Medical School 3:

Date attended 3:

Degree(s), Year Awarded 3:

Postgraduate training in surgery

Training 1:

Year 1:

Training 2:

Year 2:

Training 3:

Year 3:

Appointments

Previous appointments 1:

Previous appointments 2:

Present position:

Memberships

List the national or international surgical or gastroenterological societies of which you are a member.

a. National:

b. International:

Curriculum Vitae

Please enter a list of your publications and a brief curriculum vitae:

Sponsors

Sponsors (who must be ISDS Members)
We, from personal knowledge, regard the candidate as a person of high professional and moral standing, well experienced in the field of digestive surgery, and propose him or her as suitable for membership in the Collegium Internationale Chirurgiae Digestivae (ISDS).
The sponsors of US applicants are kindly requested to send a letter of recommendation to the secretary of the US Chapter of the ISDS.

First Sponsor's Name:

First Sponsor's Address:

First Sponsor's E-mail:

Second Sponsor's Name:

Second Sponsor's Address:

Second Sponsor's E-mail:

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