香港護理學院會籍申請表 / College of Nursing, Hong Kong - Membership Application Form (CN45a)
應屆護理學系的畢業生,可獲贈一年會籍 / 1 year membership will be granted to newly graduate Nursing Student
中文姓名 (Name in Chinese) *
英文姓名 (Name in English) *
稱謂 (Title) *
先生 Mr.
小姐 Miss
太太 Mrs.
女士 Ms.
第 1 列
香港身份證/護照號碼 (HKID/Passport No.) 首4數字 *
流動電話/傳呼號碼 (Mobile/Pager No.) *
電郵地址 (Email Address) [用作會員通訊 for future communication] *
住址 (Address) *
備註Remarks :
1. 學院免費會藉適用於二零二零年七月一日至二零二一年六月三十日,請於屆滿前辦理續會手續。
Free membership scheme starts from 1st July 2018 and ends by 30th June 2019, please renew your membership on time.
2. 有關會員的權利與義務,請參閱會章。
Please refer to the Memorandum and Articles of Association of College of Nursing, Hong Kong for the rights and duties of members.
3. 香港護理學院對申請人提供之個人資料絕對保密。
The personal information provided by the applicants will be kept strictly confidential by the College of Nursing, Hong Kong.
4. 此表格可經由電郵,傳真或郵寄方式遞交。
This form can be submitted via email, fax or by post.
5. 申請人如欲查閱或更正個人資料,請以書面致函香港護理學院,向本院的行政主任提出。地址﹕香港灣仔告士打道223號海聯大廈13字樓A及C室
To access and correct any of your information, please address your request in writing to the Executive Officer at: College of Nursing, Hong Kong, Room A & C, 13/F, Hyde Centre, 223 Gloucester Road, Wanchai, Hong Kong.
個人資料用途及聲明Personal Data Collection and Declaration
1. 本人明白及同意香港護理學院將本人所提供的個人資料只會用作聯絡、處理會籍及與學院的活動有直接關係之事宜上。
I understand and accept that the personal information I have provided to the College of Nursing, Hong Kong (“the College”) will be used only for communication, membership processing and purposes directly related to the activities
of the College.
2. 本人謹此聲明在本申請表填報的資料均屬正確及完整,本人明白若填報之資料失實,本人此次及以後的會藉申請將不會被接納。
I declare the information given in this application is, to be the best of my knowledge, accurate and complete. I understand that any false information will lead to rejection of this application and all my subsequent membership applications to the College.
日期 (Date) *
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DD
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學院專用For Office Use Only
申請編號 Serial No.
收件日期 Date Received: 經手人 Handled by : 日期Date :
接納日期 Date Accepted : 會計部 Handled by (A/C Dept.) : 日期Date :
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