The University Of Hong Kong Staff Association    香港大學職員協會

MEMBERSHIP APPLICATION FORM 入會申請表格

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英文姓名

English Name:

[EnglishName*]

中文姓名

Chinese Name:

[ChineseName]

稱謂

Title:

[Sex]

員工號碼

Staff No.:

[StaffNo*]

申請類別

Type:

[mType*]

職工服務條例類別或組別

Terms of Service or Band:

[Band]

部門

Department:

[Department]

職位

Post:

[Post]

辦公室電話號碼

Office Tel. No.:

[TelNo]

手提電話號碼

Mobile Phone No.:

[MobileNo*]

電郵地址

E-mail address:

[Email*]  

最初受僱日期：

Date of First Appointment:

[AppointmentDate]

Name of the Associate 附屬會員姓名

Spouse/配偶

[AssociateName1]

Children/子女

[AssociateName2]

[AssociateName4]

Children/子女

[AssociateName3]

[AssociateName5]

(1)

(2)

入會費 $20.00 (會員於申請入會時才須繳付一次入會費。)

Entrance Fee $20.00 (The Entrance Fee is a onetime charge when applying to become a member of this Association.)

年費Annual Subscription $70 (1月至12月January - December) 

a)

b)

c)

會員 @$70.00 (申請入會時須繳付首次年費，往後的年費定期於每年的1月份徵收。)

Full Member @$70.00 (The Annual Subscription shall be payable on admission and thereafter in the month of January every year.)

附屬會員 @$20.00 (申請入會時須繳付首次年費，往後的年費定期於每年的1月份徵收。)

Associate @$20.00 (The Annual Subscription shall be payable on admission and thereafter in the month of January every year.)

退休會員免收會費 / Retired member free of charges.

繳費方式：可以現金、支票或轉數方式繳交

(支票抬頭：HKUSA；轉數銀行賬戶：東亞銀行 176-40-4000014  賬戶名稱 HKUSA)(轉數請提供證明)  

Payment Methods: Cash, cheque (payable to HKUSA), or bank transfer.( Bank of East Asia, Account No. 176-40-4000014,

Account Name: HKUSA, Note: Please provide proof of transfer).

交回方式：

①電郵：hkusa@hku.hk；②傳真：2517 0755；③香港大學信房信箱96號；④WhatsApp:9581 6908

Return methods：

①E-mail：hkusa@hku.hk；②Fax：2517 0755；③HKU mail box No.96；④WhatsApp:9581 6908

注意事項Notes :

1)

2)

個人資料將作入會申請、統計、分析及會務推廣等用途。只有香港大學職員協會職員才能處理有關資料，

但亦可能會交由為本會提供有關服務的委託人處理，而一切資料將受到保密的。

Personal Data provided in this form will be used for processing your application, and for statistical and marketing purposes. 

The data will be solely handled by HKUSA staff but may be transferred to an authorized third party providing services to the Association

in relation to the above purposes and prescribed purposes as allowed by HKUSA and the law from time to time. 

In all such circumstances data will be treated in strict confidence.

根據個人資料（私隱）條例，申請人有權查閱及更改其個人資料，如有需要，請來函本會以便安排。

Under the provisions of the Personal Data (Privacy) Ordinance, applicants have the rights to request access to,

and to request the correction of, their personal data.

Applicants wishing to access or make corrections to their data, should submit written requests to HKUSA.

HKUSA Office: 5/F, Tsui Tsin Tong Building, HKU

申請日期Date: [SubmitDate]

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