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PLEASE AFFIX STAMP HERE Diabetes Hongkong Unit 1802, 18/F., Tung Hip Commercial Bldg., 244-252 Des Voeux Rd C, HK. Diabetes Hongkong membership Application Form Surname Mr Mrs Miss Name Year of Birth Address Telephone ID No Profession Fax E-mail Health Professional Doctor Person with Diabetes Diabetes Nurse Dietitian Relatives of people with Diabetes Name of person with Diabetes Relationship with person with Diabetes Others Others For Official Use Only Application approved / rejected on (dd/mm/yy) Membership No. Data provided must be valid and accurate. Diabetes Hongkong (DHK) reserves the right to reject applications without providing explanation to the applicant. Data collected will be used for organising activities of DHK and member correspondence. Members requesting access to or correction of personal data should write to DHK. Members have the right to receive DHK Newsletters, to subscribe to periodicals published by DHK, and to participate in its activities (e.g. camps, seminars, lectures). Members should abide by DHK regulations and respect the rights of fellow members. Violation may lead to cancellation membership. Send this application to Unit 1802, 18/F., Tung Hip Commercial Bldg., 244-252 Des Voeux Rd C, HK. Once approved, your membership card will be forwarded to you. I would like to contribute to the following work of DHK: Editing, Writing or Translating Publicity Organising Group Activities Fund Raising Computer Programming / Use of Electronic Media Others In accordance with the Personal Data (Privacy) Ordinance, information collected is recorded for administrative purposes and so we may also keep you informed of our activities. It will not be transmitted to a third party. If you require details of data information maintained, please contact us.
I/Our company would like to support Diabetes Hongkong by making a regular donation of HK$100 HK$500 HK$1,000 HK$ I/Our company would like to support Diabetes Hongkong by making a one-off donation of HK$100 HK$500 HK$1,000 HK$ Donation Methods Monthly donation by autopay Diabetes Hongkong will send you an autopay authorization form to fill in. Crossed cheque payable to : Diabetes Hongkong Cheque No 286-5-203653 Direct transfer to Hang Seng Bank account no.: 286-5-203653 and send the original copy of the bank-in slip to us. Personal Information in BLOCK LETTERS please Surname M Mrs Miss Name Address E-mail Telephone Daytime Fax Donor No. if applicable Add. : Unit 1802, 18/F., Tung Hip Commercial Bldg., 244-252 Des Voeux Rd C, HK. Tel. : 2723 2087 Fax. : 2723 2207 Website : www.diabetes-hk.org E-mail : info@diabetes-hk.org, In accordance with the Personal Data (Privacy) Ordinance, information collected is recorded for administrative purposes and so we may also keep you informed of our activities. It will not be transmitted to a third party. If you require details of data information maintained, please contact us. This donation form could be downloaded at http://www.diabetes.hk.org