(Membership Application／Information Renewal／Updating Form)
Must be filled in
Applicant / Family Member No.1 / Family Member No.2 / Family Member No.3
Membership No.
(Office Use)
Name in Chinese
Name in English
Sex / M／F / M／F / M／F / M／F
Date of Birth / Y M D / Y M D / Y M D / Y M D
Mobile Phone No.
Home Telephone No.
Home Address
Email Address
All information submitted will be handled in confidential and will only be accessed by related staff. If necessary, it will be used for program contact, and disclosed to concerned government department and non-government organizations. Applicants can request access to or correction of these personal data.
Declaration on Handing of Personal Data﹕
I declare all the above information provided in this application is true and correct.
I agree / disagree the Centre send me the service promotion materials by post / email / SMS.
《If you no longer agree our centre to use your personal data for service promotion, please contact our reception counter.》
Signature of application: Date:
Notes﹕
Membership is free of charge
Membership period: membership will be effective start from registration date until 1 year later. / Benefits for members﹕
Members can enjoy centre facilities (computer, LeisureProgram materials)
Members will receive the Newsletter in each season.
For environmental protection, please browse our website ( Facebook (sjsys) for program information
For Office Use: Staff: Date:
/ St. James’ Settlement - Youth Service
(Membership Application／Information Renewal／Updating Form)
Must be filled in
Applicant / Family Member No.1 / Family Member No.2 / Family Member No.3
Membership No.
(Office Use)
Name in Chinese
Name in English
Sex / M／F / M／F / M／F / M／F
Date of Birth / Y M D / Y M D / Y M D / Y M D
Mobile Phone No.
Home Telephone No.
Home Address
Email Address
All information submitted will be handled in confidential and will only be accessed by related staff. If necessary, it will be used for program contact, and disclosed to concerned government department and non-government organizations. Applicants can request access to or correction of these personal data.
Declaration on Handing of Personal Data﹕
I declare all the above information provided in this application is true and correct.
I agree / disagree the Centre send me the service promotion materials by post / email / SMS.
《If you no longer agree our centre to use your personal data for service promotion, please contact our reception counter.》
Signature of application: Date:
Notes﹕
Membership is free of charge
Membership period: membership will be effective start from registration date until 1 year later. / Benefits for members﹕
Members can enjoy centre facilities (computer, LeisureProgram materials)
Members will receive the Newsletter in each season.
For environmental protection, please browse our website ( Facebook (sjsys) for program information
For Office Use: Staff: Date:
Updated 3/2018 Updated 3/2018