樂齡科技平台 – 會員申請 Gerontechnology Platform – Membership Application
如欲參與「樂齡科技平台」並接收最新資訊,敬請填妥以下表格申請成為會員。

If you would like to join the Gerontechnology Platform and receive the latest information, please fill in the membership application form below.
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1(a). 稱謂 Title *
1(b). 英文姓氏 Surname in English *
請按香港居民身份證上所示填寫as shown on the HK Identity Card.
1(c). 英文名字 Given Names in English *
請按香港居民身份證上所示填寫as shown on the HK Identity Card
1(d). 中文姓名 Full name in Chinese (先寫姓氏 Surname first) *
如未能提供,請填「N/A」。 If you are not able to provide Chinese Name, please type in 'N/A'.
1(e). 性別Sex *
1(f). 年齡 Age *
2(a). 職業 Occupation *
2(b). 職銜 Job Title *
2(c). 所屬機構/公司中文名稱(如適用)Organisation/Company Name in Chinese (if applicable) *
2(d). 所屬機構/公司英文名稱(如適用)Organisation/Company Name in English (if applicable) *
2(e). 所屬國家/地區(如適用) Country / Region (if applicable) *
2(f). 所屬機構/公司類別 Organisation/Company Category *
3. 電郵地址(用作登入帳戶)Email Address (used for account sign in) *
登入詳情將於日後提供。Log-in details will be provided later.
4(a). 聯絡電話(連區碼) Contact Number (with Country Calling Codes) *
E.g. +852-21234567
5. 您是照顧者嗎?Are you a Caregiver? *
6. 您是殘疾人士嗎?Are you a Person with Disabilities? *
7. 貴機構/公司想透過「樂齡科技平台」獲得甚麼資訊?What kind of information would you like to obtain through the Gerontechnology Platform? *
Required
8. 如何得知「樂齡科技平台」?How did you find about the Gerontechnology Platform? *
Required
9. 本人了解並同意「樂齡科技平台」會員的條款及細則 和 私隱政策。 I understand and agree to the Terms and Conditions of Gerontechnology Platform Membership and Privacy Policy. *
請按以下連結參閱「樂齡科技平台」會員的條款及細則 和 私隱政策︰ For the Terms and Conditions of Gerontechnology Platform Membership and Privacy Policy, please refer to the following: https://cutt.ly/on5pJk6
Required
10.閣下是否願意接受我們個別邀請參與「樂齡科技平台」的相關活動? Do you wish to receive invitation of the relevant events of the Gerontechnology Platform? *
11. 閣下是否願意收取「樂齡科技平台」的會員通訊及相關資訊? Do you wish to receive the newsletter and relevant information from the Gerontechnology Platform? *
感謝 閣下申請成為「樂齡科技平台」的會員。
Thank you for your application for the membership of the Gerontechnology Platform.
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