Date of receipt: _______________________ 0707 Revised H4 Terms of Service 0 and T (Full Time) Appointees
THE UNIVERSITY OF HONG KONG
INSTITUTE OF HUMAN PERFORMANCE
Application for the Use of University Sports Facilities: Term of Service 0 and T (Full-Time) Appointees
Please read the notes overleaf and then fill in the details as below:
Personal Details
Name of University appointee (Mr/Ms): ______________________________________________________________________ (SAME AS STAFF CARD) HKID/Passport No: ___________________________________ Staff number: ______________________________________ Department/Unit: _____________________________________ Position held: _____________________________________ (as given in Letter of Appointment) Staff Card OR FAC** (if applicable) No. : __________________ Retirement or contract end date: _________________________ Telephone No.: _______________________________________ Email: __________________________________________
Family (if applicable)
Name (same as the HKID Card/Passport) Spouse Child Child Child Child Child
NA/RE* NA/RE*
Date of Birth
Age
FAC** No.
For Official Use Only
NA/RE*
NA/RE*
NA/RE*
NA/RE*
NA/RE*
Please put ‘’ in appropriate boxes: Section I - Status New Application Renewal (if applicable for principal card) Applicant without Staff Card or FAC Staff cardholder/FAC holder
Section II - Total number of Applicants (See overleaf for types and fill in number) 1. 2. Signature I have read the conditions overleaf and confirm my acceptance of them. I hereby apply for use of University sports facilities. I authorize The University of Hong Kong to deduct the fees as agreed by the Committee of Management of Institute Of Human Performance; the fee of $35 for the first issuance of EACH FAC from my salary and then to charge the membership fee annually, until this arrangement is cancelled by me in writing to the Director of Institute Of Human Performance; my retirement or contract end date stated as above whichever is earlier and by disabling my staff card (and that of my family FAC(s) if applicable) to access sports facilities. Date * ** Signature Delete whichever is inappropriate (NA: New Application; RE: Renewal) FAC = Facility Access Card For Official Use Remark: _____________________________________________________________________________________________________ Total number: ____________ x HK$35= __________________ Total number: _______________________________________
Date of receipt: _______________________ 0707 Revised H4 Terms of Service 0 and T (Full Time) Appointees
Eligibility Full-Time Staff on Terms of Service 0 & T and their family members are eligible to use University sports facilities, provided they pay the fees prescribed by the University and comply with IHP’s policies and rules. Membership types Principal member – university appointee Spouse Child (aged 18 and below) Senior Child (aged 19 to 24) – each senior child will be charged a separate fee Procedure for both New Application and Renewal For both new application and renewal, the user should send this application form, duly completed and signed, to Flora Ho Sports Centre, Institute Of Human Performance, 111-113 Pokfulam Road, Pokfulam, Hong Kong. Members can obtain access to sports facilities (see below) at General Office, Flora Ho Sports Centre at the above address during office hours no earlier than 7 (IHP General Office) working days after submitting the application. For renewal, the cardholders should produce their expired cards at the time of collecting the IHP sport membership. The IHP will not return any notification for this application. For enquiry concerning membership application, please call 28173657 or 28174046. Obtaining Access to Sports Facilities 1. For Applicants without Staff Card or FAC(s) If you or your family members do not have Staff Card or FAC(s), please come in person to take photo or bring passport size colour photo(s) taken within the past 6 months to IHP during office hours. On the back of the photo(s), please print Name, HKID/Passport No. and relationship to the appointee where applicable. 2. For Applicants with either Staff Card or FAC(s) If you or your family members have Staff Card pr FAC(s), please present your card(s) to IHP for encoding your cards to access sports facilities. Fee Types Fees once paid are non-refundable and will be categorized as below: Membership fee for less than 12 months will be charged on monthly pro-rata basis Annual membership fee will be made every November Senior child annual membership fee is $270 each The first issuance of EACH FAC is $35 Replacement fee for each FAC is $100
Scale of Annual Membership Fees (subject to review)
Principal only Principal & family (Excluding Senior Children) Every Senior Child aged 19-24 $195 $300 $270
Payment The deduction fees will be made at the time of application and then every November thereafter from salary. If you wish this payment to stop, you may cancel your membership as below. Cancellation Members must write to Director for any cancellation of membership before October and present both Staff Card with all family FAC(s) for deactivation before 15th of October. Otherwise, the annual membership deduction will continue automatically until your membership expires. Admission Staff Card/FAC(s) must be produced for each entry to any University sports facility and booking of facilities. After their expiry date, these cards are invalid. On withdrawal of membership or termination of employment, staff card and all family FAC(s) issued for all users should be presented in person or on behalf of your family members for deactivation of membership. IHP RESERVES THE RIGHT TO ALTER THE CONDITIONS OF MEMBERSHIP AT ANY TIME.
Date of receipt: _______________________ 0707 Revised H4 Terms of Service 0 and T (Full Time) Appointees
STC/ms July 2007