HKUSPACE-MPAS - 入會申請表 Application Form

    個人資料 Personal Particulars

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    1. 本人曾修讀「香港大學專業進修學院調解實務課程」I have attended the following mediation course(s) organized by HKUSPACE

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    2. 本人曾修讀其他相關調解課程/擁有相關調解經驗 I have attended the following related mediation course(s)/have mediation experience

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    3. 本人已取得認可調解員資格 I am an accredited mediator

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    備註Remarks

    (1) 個人資料(私穩)條例通知 Personal Data (Privacy) Ordinance Notice 以下為提供有關個人資料予香港大學專業進修學院調解實務校友會(校友會)通知的內容: Please refer to the following points pursuant to the personal data (privacy) ordinance when supplying data in the application to the HKUSPACE Mediation Practice Alumni Society (the Society). (a) 你所提供的個人資料,將會被校友會作為申請為校友會會員之用,因此,這些資料會供校友會在工作上需要知道資料的執行委員會使用。 Personal data provided in this application form will be used solely for the purpose of applying to be a member of the Society, and in this connection the data herein will be dealt with by the Executive Committee of the Society. (b) 校友會於完成批核你的申請後,會將你呈交的申請表格存檔。 After an application for membership of the Society has been duly processed, the applicant’s papers will be retained in a file established by the Society. Such information will be retained by the Society for as long as it deems necessary or useful. (c) 校友會可能會把你的個人資料用作促銷,而校友會為該用途必須獲得你的同意(包括表示不反對),如反對校友會使用你的個人資料作促銷用途,請以書面向校友會執行委員會提出「拒收直接促銷通知」。 The Society may use your personal data for direct marketing. Before using your personal data for such purposes, the Society will obtain your written consent (including no objection). You may opt out your personal data for direct marketing purposes by writing to the Executive Committee of the Society. (d) 根據個人資料(私隱)條例規定,你有權就校友會備存有關你的個人資料提出查閱及改正要求,查閱及改正要求應以書面向校友會執行委員會提出。 Under the provisions of the personal data (privacy) ordinance, an applicant has the right to access to, and the correction of the personal data as retained by the Society. An applicant wishing to access or make corrections to the personal data should submit written request to the Executive Committee of the Society. (2) 會員 Membership (a) 基本會員:凡曾修讀不少於一項由香港大學專業進修學院舉辦調解課程之人士。 Full Members: Individuals who have completed at least one mediation course offered by the HKUSPACE. (b) 聯席會員:凡曾修讀由其他學院/機構舉辦之調解課程/由校友會執行委員會確認對校友會有貢獻之人士。 Affiliated Members: Individuals who have taken mediation courses offered by other education institute / have contributed to the Society that the Executive Committee deems appropriate. (3) 入會費 Admission Fee: 基本會員及聯席會員入會費均為港幣一百元正 Admission Fee for the Full Members and Affiliated Members is HK$100. (4) 申請手續 Application Procedure 請將填妥之入會申請表連同劃線支票(支票抬頭:香港大學專業進修學院調解實務校友會),寄回香港金鐘道95號統一中心6樓602A室香港大學專業進修學院調解實務校友會收。 Please complete the application form and send with a crossed cheque made payable to“HKUSPACE Mediation Practice Alumni Society” to HKUSPACE Mediation Practice Alumni Society at Room 602A, 6/F, United Centre, 95, Queensway, Hong Kong.

    聲明 Declaration

    1. 本人已細閱、明白及同意有關個人資料(私隱)條例通知。(備註(1)) I have read, understood and agreed to the Personal Data (Privacy) Ordinance Notice.(Remarks (1)) 2. 本人就上述所提供資料確實無訛; I declare that the information given in support of this application is accurate and complete. 3. 若本人成為校友會會員, 願意遵守校友會會章。 I do undertake in the event of my admission as the member of the Society, to abide by the Constitution of the Society.
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