Membership Application Form

Hong Kong University
Alumni Association of Ontario, Canada
c/o 18 Crown Steel Drive, Suite 202,
Markham, Ontario L3R 9X8
Fax: (905) 475-2494

Please complete the form and send it together with your cheque (payable to HKU Alumni Association of Ontario) to the above address.
Membership Fee: $20 a year or $80 for 5 years or $150 for life membership

Please check and select the appropriate boxes

Title:
Name (in full):
Surname first, maiden name for ladies 		Name in Chinese:
Corresponding Address:
City:
Province: Postal Code:
Home Tel.: Cell Phone.:
Office Tel.: Email.:
Graduate Year: (if worked at HKU, when employed there)
Degree(s) awarded:     Faculty/Dept: Hostel/Hall:
Date of Birth: (DD/MM/YY)       Occupation:

Cheque/Cash enclosed: $ (Please make cheque payable to HKU Alumni Association of Ontario.)

Free membership for spouse if he/she is also a HKU graduate.
Please complete a seperate information sheet for your spouse for record purposes.

Is your spouse
Name of Spouse (in full) :
(maiden name for ladies) 		Chinese Name:
Home Tel.: Office Tel.:

By submitting this application, you AGREE AND CONSENT that we may collect, use  
and disclose your information in accordance with our privacy policy.

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Please send questions and comments to
hkuaaont@www.hku.hk