第十二屆香港模擬立法會參加者報名表格
以下列表為新報名者之可用優惠:
原價: HKD 850

1.電子表格:減免HKD 50

2.多人同行[1]:同學可邀請同學或朋友一同參加,介紹人邀請第一位同學減免HKD 50,邀請第二位同學再減免HKD 150,邀請第三位同學再減免HKD 100,所以介紹人可累積減免HKD 300,而被邀請者則可獲HKD 50減免。

3.出席率達八成,活動完結後籌委會將回贈HKD 150

註:優惠2與3只可選取其中一項(以較優惠者為準)。對於所提供之各項報名優惠及報名條款,本會保留最終決定權。
Part I 個人資料
PART I PERSONAL PARTICULARS 個人資料
Name 姓名: *
(in English)
Your answer
*
(中文)
Your answer
*
Alias(別名)
Your answer
Gender 性別: *
Age 年齡: *
Your answer
Date of Birth 出生日期: *
MM
/
DD
/
YYYY
Home Phone No 電話: *
Your answer
Mobile Phone No 手提: *
Your answer
Address 地址(in English): *
Your answer
*
(District 地區)
Email Address 電郵地址: *
Your answer
School Name 學校名稱: *
(in English)
Your answer
*
(中文)
Your answer
Form 年級: *
Your answer
Interest 興趣: *
Your answer
PART II 獎項/獎學金/專業資格
PART II AWARDS/ SCHOLARSHIPS/ QUALIFICATIONS 獎項/獎學金/專業資格


Please list the most recent item first 請由近至遠依次序列出
Please use the space provided ONLY 只可使用本欄提供之空位填寫
Please list not more than 3 awards/scholarships/qualifications 請列出不多於三項獎項/獎學金/專業資格
包括:Year 年份 Organization 組織 Achievement 成就
Your answer
PART III 校外/校內職務
PART III RESPONSIBILITIES/ POSITIONS HELD 校外/校內職務


Please list the most recent item first 請由近至遠依次序列出
Please use the space provided ONLY 只可使用本欄提供之空位填寫
Please list not more than 5 responsibilities/ positions held/ extra-curricular activities/ voluntary services 請列出不多於五項職務/課外活動/義工服務 *
包括:Year 年份 Club/Organization 學會/組織 Post/ Position Held/ Name of activity 職位/活動名稱
Your answer
PART IV緊急聯絡人資料
PART IV EMERGENCY CONTACT INFORMATION 緊急聯絡人資料
Name姓名: *
(in English)
Your answer
*
( 中文 )
Your answer
Relationship 與參加者關係:
Your answer
Contact No. 聯絡電話: *
(1)
Your answer
(2)
Your answer
PART V APPLICATION DISCOUNT 報名優惠
請選擇所享用之報名優惠(一) *
請選擇所享用之報名優惠(二)
請填寫多人同行之另外參加者姓名 *
若此欄未有填寫,參加者將不能獲得多人同行之優惠 (邀請者請填寫被邀請者姓名。被邀請者則填寫邀請者姓名)
Your answer
PART VI 參加者聲明及重要事項
PART VI DECLARATION OF APPLICANT AND IMPORTANT INFORMATION 參加者聲明及重要事項

請在此參閱參加者聲明及重要事項:
https://drive.google.com/open?id=0Bzgl4h-nX87dMTJzWnlBTEZQLVU
PART VII 退款安排
PART VII REFUND ARRANGEMENT 退款安排

Refund (if any) by the Association will be paid by cheque.
本會將以支票形式發還所有退還款項(如有)。
*
I agree the refund cheque be made payable to: (Please fill in the Payee's name)本人同意退款支票將支付予:(請填上支票抬頭)
Your answer
Part B 乙部 (To be completed by Applicant's parent/ guardian 由參加者家長或監護人填寫)
Please be reminded that the hard copy of parent/guardian's consent (for applicant under 18) has to be printed out and handed in on interview day.請於出席面試當天帶同家長/監護人同意書 (18歲以下參加者必須填寫) 交予面試人員。請在此下載家長/監護人同意書:
https://drive.google.com/file/d/1RmTjQWTT9XtCxifmaogGbSaNxx9pOALk/view?usp=sharing
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