HonoraryLifeMemberMembershipFee.PDFVIP

THE UNIVERSITY OF HONG KONG STAFF ASSOCIATION 5/F, Tsui Tsin Tong Building, The University of Hong Kong, Pokfulam, Hong Kong. Tel: 3917-2112/ 4733/ 4572 Fax: 2517-0755 Mail Box: 63 Email: hkusa@hku.hk Website: http://www.hku.hk/hkusa Honorary Life Membership Application Form Name: (English) Chinese) Sex: Staff No.: Marital Status: Terms of Service or Band Department: Post Date of Retirement: Contact Phone No.: E-mail address: Correspondence Address: Name of the Associate Spouse/Children Date of Birth Honorary Life Member Membership Fee An Honorary Member may become an Honorary Life Member by paying a one-off fee which equals to 10 years’ annual subscription (current rate): $________________________________(current rate) x 10 = $______________________________ NOTES : 1) 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. 2) 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