Membership Application Forms_Individual_ENGLISH-31-3-2009 by sdfwerte

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									CONFIDENTIAL!!                                                                                                                   Prepared 31 March 2009

                                                                                            SASA STAFF USE ONLY
                                                                              Staff: ______________            Date: __________
                                                                                Data Entry       Card Produced        Copy to ICYS
                                                                                 Card Received (Date: _______)
                                                                              Remark: ___________________________________

                                         Project SASA (Project South Asians Support Alliance)

                                                  MEMBERSHIP APPLICATION FORM
                                                    (INDIVIDUAL MEMBERSHIP)
 Personal Data:
     □ New member               □Renewal               □ If you also want to enroll as volunteer of SASA, please this box.
                                      ICYS                                  Name                         Date of Birth
        Membership No.                                                                                                                       Gender         Age
                                  Membership No.                      (IN BLOCK LETTERS)                                DD/MM/YYYY

      SA ______( )2009                                                                                                     /     /



   Highest Level of Education Obtained:                           Primary Level         Secondary Level (Form ________)
                                                                  University Level or above

 Occupation:             Student (Primary/Form/Year: ____________) (School Name: _____________________)
            Employed (Type of Job: ____________________) (Company Name: ______________________)
            Unemployed
            Others (Please specify: ______________________________________________________)

 Telephone No.:                                          (Home)                                     (Mobile)                                       (Office)
 Address: ______________________________________________________________________
 Email: _______________________________

 Language Use:
     Spoken Language: (you can more than one)
       Cantonese   English    Urdu     Hindi                               Others (please specify:                                                      )

     Written Language: (you can more than one)
      Chinese       English     Urdu    Hindi                              Others (please specify:                                                      )

Contact for Emergency:
Contact person: ___________________________ Relationship with applicants: ______________

Contact phone no: _________________________

Enrolment to Membership of Happy Teens Club:
Do you want to join the membership of one of the Happy Teens Clubs below?                                         Yes            No

If Yes, which Happy Teens Club you want to join?
   Shamshuipo Central Happy Teens Club                                                                  Shamshuipo East Happy Teens Club
   Kwun Tong Happy Teens Club                                                                           North Point Happy Teens Club

                                            Project SASA (Project South Asians Support Alliance)
                          2/F, Lee Hong House, Shun Lee Estate, Kwun Tong, Kowloon, Hong Kong SAR
                                 Tel: 3188-3195     Fax: 2790-8955     Email: psasa@hkcs.org

X:\[Common]\Admin\SASA Form\2009-2010\SASA-Membership Form_09-10\Membership Application Forms\Membership Application Forms(Individual)ENGLISH-31-3-2009-SASA.doc
CONFIDENTIAL!!                                                                                                                   Prepared 31 March 2009

                                                                 Notice to Members
 Rules and Regulations:
    Member should obey rules in SASA, other Ethnic Minority Services units and the Happy Teens Clubs
    Member should produce a valid membership card when using the service
    Membership card is not transferable
    Membership is valid for one Year
    Applicant should be aged over 4

 Procedure under Personal Data (Privacy Ordinance)
    The personal data you provided will be used only for providing service to you and your family.
    Data will be kept confidential except the following conditions:

 1. The use of your personal data is needed for assessment in applying services in other
    government Departments another other organizations, or
 2. Upon your agreement to disclose your personal data to organizations concerned or
 3. Statutory requirement to disclose yours personal data to court or government departments

 Request for Reading and Your Personal Data
   The personal data you provided will kept confidential for providing service to you and will be
   destroyed after the end of service, Except for the exemption started in Personal Data (Privacy)
   Ordinance, you can request to read and amend your personal data kept in our agency.
   Administration fee will be charged for the related procedures.

 Remarks
   Renewal of membership card is required when the card is lost, expired or damaged.
   Photo taken during group and program will be used for agency service promotion and
   publication of annual report.
   Membership fee of SASA: Free of Charge
   Membership fee of Happy Teens Clubs: HK$29 (Individual Membership)
                                         HK$60 (Family Membership)
                                               Agreement
            I had read the above “Notice to Members.”
            I agreed to provide our personal data to Hong Kong Christian Service Project SASA
            and the ________________________ Happy Teens Club.
            I agreed to comply to all the contents stated on the above Notice.
            I also agreed to receive Newsletters and related service information of SASA, ISSA
            and the above Happy Teens Club.
   Name of Applicant/Parent/Guardian: ________________                                                        Signature: ______________
                                                                        Date: _________________
                    This part must be completed by parent/guardian for applicant under age 12.

 HAPPY TEENS CLUB STAFF USE ONLY
 Receipt No.: __________________                           Fee: _______________                                    Date: _________________
 Membership No.:______________                             Responsible staff: ______________ Data Entry: ____________
 Membership Card Received by members:                             No             Yes Signature of Member: __________________


X:\[Common]\Admin\SASA Form\2009-2010\SASA-Membership Form_09-10\Membership Application Forms\Membership Application Forms(Individual)ENGLISH-31-3-2009-SASA.doc

								
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