CO129-519-5 Nurses Registration Ordinance- 1929- Bill 19-9-1929 - 25-2-1930 — Page 34

34

13

SECOND SCHEDULE.

FORM I.

NURSING BOARD FOR THE COLONY OF HONG KONG.

Nurses Registration Ordinance, 1929.

Application for Registration for Existing Nurses for Admission to the General Part of the Register.

To the NURSing Board for THE COLONY OF HONG KONG

Full Christian names and Surname.

Place and date of birth.

State here whether single, married or widow. If married or widow, give maiden name.

Full Permanent Postal Address.

hereby request the Nursing Board for Hong Kong to enter my name upon the General Part of the Register of Trained Nurses maintained by the Board. I forward herewith the fee of $10*, and I promise, in the event of my being so registered, and in considera- tion thereof, to be bound by, and to conform in all respects to the Rules and Regulations for the time being in force.

I forward herewith my Certificate of Training (and copy of the same) from

If no certificate is held explain the reason,

The following are the places in which and dates of the times during which I was bona fide engaged as a nurse in attendance on the sick :-

PLACES.

DATES.

Month. Year.

From.....

Month. Year,

..to......

From..

.to......

From.

.to......

From..

.to......

From..

.to...

From...

.to..

* If a nurse's application for registration is not accepted the $10 Fee will be returned.