Page 50 - 香港老年學會（2019-2020年報）

(生效日期: 01/08/2020)

FOR OFFICAL USE ONLY
此欄由本會填寫
香港老年學會  會籍申請表 No: 1. 會籍有效期由每年之一月一日至十二月三十一日。
Membership Dues: The Association’s membership is valid from 1st January to 31st December.
Year: _______________________
HONG KONG ASSOCIATION OF GERONTOLOGY  Cash  Cheque  ATM 2. 會籍一經批核，已繳之會員費概不退還。
MEMBERSHIP APPLICATION MEM/AB - Once approved, initial administration fee and membership subscriptions are non-refundable.
* 必須填寫 Must be filled 3. 所有「個人會員」都有提名及被提名加入本會之理事會的權利。
新會員 更改資料 All Ordinary Members possess the right to nominate and to be nominated for the Association’s Council.
*會籍類別 Membership Category (只可選一項 Select one item only) New 續會 Change of
Member Renewal Information 付款方法 Payment method
1月1日至6月30日入會
個人會員  $200/ 1年 year  $300/ 2年 years  $400/ 3年years    現金：親身至尖沙咀金巴利道35號金巴利中心一樓
Join from 1 Jan to 30 Jun
 Ordinary 7月1日至12月31日入會 郵寄/親身交付支票：抬頭「香港老年學會」，郵寄至「尖沙咀金巴利道35號金巴利中心一樓」，支票背
Member Join from 1 Jul to 31 Dec  $150/ 1年 year  $250/ 2年years  $350/ 3年years    面寫上申請者的姓名及聯絡電話。
機構會員 轉帳：匯豐銀行帳戶600-633903-002，轉帳後請於三個工作天內將轉帳紀錄（入數紙），寫上姓名及聯絡
  $600/ 1年year  $1100/ 3年 years   
Organization Member 電話，拍照並以whatsapp傳送至手機號碼9844 6835或掃描至account@hkag.org 或郵寄至本學院
 學生會員(全日制)  $150/ 1年year    Cash: Pay at our reception counter at 1/F., Kimberley House, 35 Kimberley Road, Tsim Sha Tsui.
Student Member (Full-Time) Cheque: Prepare a cheque payable to “Hong Kong Association of Gerontology”, and send to “1/F., Kimberley
長者會員(60歲或以上)
  $150/ 1年year    House, 35 Kimberley Road, Tsim Sha Tsui”. Applicant’s name and contact number should be written at the back
Associate Member (Aged 60 or above)
of the cheque.
Bank transfer: Transfer to our HSBC account 600-633903-002, and send the transfer record to us within 3
個人資料 Personal information (只適用於個人、學生及長者會員 For Ordinary / Student / Associate Member only) working days. You can either send the image of the transfer record to our mobile via whatsapp at 9844 6835,

稱謂 Title:  Mr 先生  Ms 女士  Miss 小姐  Dr 醫生  Prof 教授  Dr 博士 email the copy to account@hkag.org or send us by mail.

性別 Gender:  Male 男  Female 女 個人資料收集聲明 Personal Information Collection Statement
*英文姓名: *中文姓名:
*Name 姓氏 Last Name 名稱 First Name *Name in Chinese 香港老年學會致力保護 閣下的個人資料，絕不會出售或與第三方交易 閣下的個人資料。為確保閣下能有
機構: 效地接收有關本會資訊及推廣，本會會使用 閣下之電郵地址、通訊地址、手提電話號碼、電話號碼及其
Organization: 他已收集資料，並透過各種通訊渠道向 閣下發放本會資訊。

職位 / 銜頭: 最高學歷: Hong Kong Association of Gerontology puts efforts to protect the personal information collected, and would not
Position / Title: Highest Academic Qualification: sell the information to third parties. To ensure you can receive our updates and activities effectively, we would
use your email address, correspondence address, mobile number, telephone number and other collected
*通訊地址: information for updates and activities release.
*Correspondence Address:
I. 收集資料的目的 Purpose of Collection
*電郵地址 傳真號碼
*Email Address: Fax No. : 閣下提供的個人資料，會用作下列一項或多項的用途：
The personal data you provided may be used for one or more than one of the following purpose(s)：
*流動電話 住宅電話 辦公室
*Mobile: Telephone: Office: (a) 處理此表格列明的報名、付款 Process registration and payment as indicated in this form；
(b) 統計及研究用途 Statistical and research purposes；
*請選擇你所屬的行業類別 (只適用於個人會員申請) Please select the category you belong to (For Ordinary Members Only)
 類別一 行政 Administrative 法律 Law  類別四 營養 Nutrition 物理治療 Physiotherapy (c) 法例規定、授權或准許的任何其他合法用途 Other legitimate purposes as may be required or
CATEGORY 1 管理 Management 傳媒 Media CATEGORY 4 足療 Chiropody 言語治療 Speech Therapy permitted by law.
資訊 Communication 商業 Business 復康 Rehabilitation 職業治療 Occupational Therapy
政策策劃 Public Policy 財經 Finance  類別五 藝術 Arts 輔導 Counselling
策劃與發展 Planning and Development CATEGORY 5 康樂 Recreation 精神健康 Mental Health
社會工作 Social Work 長者服務從業員 Service Provider II. 資料轉交的類別 Classes of Transferees
 類別二 醫藥 Medicine 牙科 Dentistry  類別六 宗教 Religion 研究 Research 為達至第1段所述的目的，你所提供的個人資料，有需要時，會轉交香港老年學會相關部門使用。
CATEGORY 2 CATEGORY 6 教育Education 技術 Technology 科學 Science To serve the purposes mentioned in Section I, your personal information might transfer to other divisions of
 類別三 護理 Nursing  類別七 其他 (如退休, 主婦) our association whenever necessary.
CATEGORY 3 CATEGORY 7 Miscellaneous (e.g. Retired, Housewife)

 本人同意香港老年學會使用本人所提供之個人資料作為與本人聯絡及推廣活動用途。 III. 查閱及修改個人資料的權利 Access and Correction Rights
I consent to the use of my personal data by Hong Kong Association of Gerontology for the purposes of communication and activity
promotion. 根據個人資料（私隱）條例，你有權要求查閱及修改你的個人資料。如果你希望查閲或修改你的個
人資料，請致電2775-5756。
 本人已細閱、明白及同意接受後頁的個人資料收集聲明，並確認所有填報的資料均屬正確。 Under the Personal Data (Privacy) Ordinance, you have the right to request access and the correction of your
I have read, understood and agreed to accept the Personal Information Collection Statement and confirmed all information provided is personal data. If you wish to request access or make corrections to your personal information, you could call
accurate. 2775-5756.

申請人簽名 Signature of Applicant: 日期 Date: