第十一屆香港模擬立法會小組導師報名表格
小組導師報名費用: $300
第十一屆香港模擬立法會系列活動時間表 (2018年)
6月23日 (六)
第十一屆香港模擬立法會開幕典禮暨工作坊 –立法會中的分歧與合作
6月24日 (日)
立法會參觀及香港議會的入門課工作坊
6月25日至7月6日
約見立法會議員
6月30日 (六)
進階議會政治知識工作坊
7月7日 (六)
訓練日營暨中期評估
7月13至15日(五至日)
香港模擬立法會訓練營
7月28日(六)
模擬立法會選舉論壇
8月4至5日 (六、日)
香港模擬立法會會議
8月11日(六 晚上)
議員分享﹣立法會中的挑戰與契機
8月12日 (日)
第十一屆香港模擬立法會閉幕典禮
PART I 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: *
Your answer
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
Faculty/ Programme 學院/學系: *
(in English)
Your answer
Year 年級: *
Your answer
Interest 興趣: *
Your answer
Spoken 說話能力 *
1= Fluent 流利 2= Good Command 良好 3= Fair 一般
1
2
3
English 英語
Cantonese 中文(廣東話)
Mandarin 中文(普通話)
Others 其他語言(請註明):
Your answer
Fluent 流利
Fair 一般
Written 書寫能力 *
1= Fluent 流利 2= Good Command 良好 3= Fair 一般
1
2
3
English 英語
Chinese 中文
Others 其他語言(請註明):
Your answer
Fluent 流利
Fair 一般
PART II 個人履歷 Curriculum Vitae
Please email your curriculum vitae of no more than 2 pages to 2018mlc11@gmail.com.
請附上一份不多於 2 頁的個人履歷並電郵至 2018mlc11@gmail.com
*
PART III 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 III 參加者聲明
PART III DECLARATION OF APPLICANT 參加者聲明


1. I declare that the information given in this form is complete, true and accurate, and I understand any
misrepresentation of facts may lead to disqualification of the captioned event.
2. I agree that should there be any subsequent changes of any information given in this form, I should inform the
Association immediately.
3. I have read in details the Important Information provided in Part VIII of Part A of this form.
4. I agree to the usage of my personal data and information provided under this form as a basis of selection of
applicants and for the communication between the Association and me, and for any other purposes related to or in
connection with the programme. I further agree that the Association may release my personal data and information
to any participating organizations or relevant personnel when it is required for the running of the programme.
5. I understand that the Association has the right to add or delete any workshops or sessions, or change the format or
guests of any session without prior notice.
6. I acknowledge that email is the common and most-frequently used means of communication between the
Association and me, and it is my responsibility to timely obtain all updates and information of the event from my
email account.
7. I understand that the Association reserves the right to make all final decisions as to all kinds of arrangement of the
programme.

1. 本人聲明一切所填寫的資料均屬完整及正確,並明白提供任何含誤導成份的資料有可能使本人失去活動參與的資格。
2. 如有任何資料的變更或更改,本人會即時及如實通知貴會。
3. 本人已仔細閱讀報名表格甲部第 VIII 部份所列出的重要事項。
4. 本人同意及明白所有填寫的個人資料將會用作甄選及聯絡本人之用途以及其他一切與活動有關的用途,並同意 貴會
可根據活動進行的需要,將有關個人資料發放予任何參與機構或相關人士。
5. 本人明白 貴會有權自行增加或刪去任何工作坊或活動部份,或更改活動形式或出席嘉賓。
6. 本人明白電郵為是次活動最常用之溝通方法,本人亦會經常檢閱個人的電郵戶口以得悉活動的最新消息及資訊。
7. 本人明白 貴會保留一切有關安排最終之決定權。

*
PART IV重要事項
PART IV IMPORTANT INFORMATION 重要事項

1. Please make photocopies of the application form if necessary.
2. Unless otherwise directed, please return the completed form with necessary documents to “P.O. Box No.72521,
Kowloon Central Post Office, Hong Kong”
3. (If applicable) please attach to the application form a crossed cheque made payable to “Hong Kong Young
Leaders Development Association” for payment of the admission fee. Please write the applicant’s name and
contact details at the back of the cheque. Unsuccessful applicants will have the paid fees refunded in full.
4. Applicants will be informed by email of the arrangement of the interviews and application results.
5. (If applicable) unless otherwise expressly stated, once the applicant is admitted to the programme, any paid
programme fee is non-refundable in all circumstances.
6. Successful applicants are required to attend all activities of the programme.

1. 如有需要, 請自行複印此報名表格。
2. 除另有訂明外,請將填妥的報名表格,連同所需文件,電郵或郵寄至「香港九龍中央郵政局 郵政信箱72521號」。
3. (如適用)請以劃線支票(抬頭:「香港青少年領袖發展協會」)繳付活動費用,並連同報名表格一併交回。
請在支票背面寫上參加者的姓名及聯絡資料。未被取錄的參加者將獲得全數退還款項。
4. 本會將以電郵通知參加者活動面試安排及取錄結果。
5. (如適用)除另有訂明外,參加者一經取錄,在任何情況下,所有已繳付之活動費用一概不獲發還。
6. 除特別情況外,參加者並必須出席所有活動。

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