專門服務申請表 / Application Form for Special Services
機構名稱 / Name of Organization *
聯絡人 / Contact Person *
聯絡人電話 / Telephone Number *
聯絡人電郵 / Email Address *
服務日期 / Date of Services *
服務時間 / Time of Services *
地址 / Address *
能否於本中心安排的場地進行服務？/ Could services be proceeded at venue arranged by our centre? *
參加人數 / Number of participant *
語言 / Use of Languages *
內容 / Content *
如：服務類別，服務對象，對象背景等等 / Example: Type of services, service targets, targets' background
期望得到的幫助 / Expected Outcome *
各下能提供之樂器 / Music Instrument Provided by Client *
如：搖鼓 x 5，結他 x 1等 / Example: Tambourine x 5, Guitar x 1 , etc.
各下能提供之設施 / Facilities Provided by Client *
如：場地，音響設施等 / Example: Venue, Microphone, etc.
預算 / Budget *
港幣 / HKD
備注 / Remarks
轉介人 / Referee
申請日期 / Date of application *
MM
/
DD
/
YYYY
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