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寒冬送暖2015
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Name in English:
*
Your answer
Name in Chinese(中文姓名)
*
Your answer
Membership
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Member
Non-member
Contact No. (Mobile preferable)
*
Your answer
Year of Graduation
*
Your answer
Email
*
Your answer
Gender
*
Male
Female
Joined elderly service (including organized by HKUAA / other parties) before
*
Yes
No
No. of participant(s) (including you)
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Your answer
Information of other participants (if applicable)
1. Name
Your answer
1. Age
3-11 years
12-17 years
18 or above
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1. Gender
Male
Female
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2. Name
Your answer
2. Age
3-11 years
12-17 years
18 or above
Clear selection
2. Gender
Male
Female
Clear selection
3. Name
Your answer
3. Age
3-11 years
12-17 years
18 or above
Clear selection
3. Gender
Male
Female
Clear selection
4. Name
Your answer
4. Age
3-11 years
12-17 years
18 or above
Clear selection
4. Gender
Male
Female
Clear selection
5. Name
Your answer
5. Age
3-11 years
12-17 years
18 or above
Clear selection
5. Gender
Male
Female
Clear selection
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