The Hong Kong Association for Science and Mathematics Education

MEMBERSHIP (LIFE) APPLICATION FORM

To:Membership Secretary
Hong Kong Association for Science and Mathematics Education
Room 14, 1/F, Po On Court,
1-15 Po On Road, Shamshuipo, Kowloon.

(Please read the notes at the back before completing this form. Personal data collected will only be used for record and statistical purposes. To support the green movement, the HKASME is sending materials via email as far as possible. )

Iwould like to join the Association as a Life Member.

Membership payment method (Pls tick): Cash Cheque

* delete as appropriate

Name: * Prof./Dr./Mr./Ms./Mrs.______( ______)

In Englishin Chinese, if applicable

School/Organization:______

Address:______

Home Address:______

Contact Phone:Home: ______Office: ______Mobile:______

Email: ______Member No.:______

(if known)

I would like to receive these items (Pls tick) Science  Mathematics  Council/General News via email.

(Please substantiate your request if you wish to have the above items sent through regular post)

For all other correspondence sent via regular post, please deliver to my (Pls tick) Office Home

Type of Organization (Pls tick): Primary School Secondary School Tertiary Institutions

 EDB HKEAA Others:______

Qualification (Pls tick): Sub-degree teacher Training University University+Cert. Ed./PGDE

 Higher Degree Others:______

Major: ______Minor: ______Year Graduated:______

Subjects Teaching (for teachers only) : * delete as appropriate

Major ______at * Tertiary / S. 4 - 6 / S. 1 - 3 / Prim / Pre School

Minor ______at * Tertiary / S. 4 - 6 / S. 1 - 3 / Prim / Pre School

Teaching Experience: ______years.

Date:______Signature:______

The Hong Kong Association for Science and Mathematics Education welcomes dedicated members to upgrade their membership to “Life” status. The current fee for a “Life Member” is HK$3000 and is payable upon application. The Council will review each application on its own merit and if the application is not granted, the fee will be promptly returned to the applicant.

Life Membership Fee is payable either by cash or cheque, please choose the one most convenient to you:

1.Cash

Please complete and return this Application Form together with an appropriate amount.

2.Cheque

Please complete and return this Application Form together with a cheque of an appropriate amount, crossed and payable to ‘HKASME Ltd’.

For enquiries, please contact the HKASME Office:

Hong Kong Association for Science and Mathematics Education

Room 14, 1/F, Po On Court,

1-15 Po On Road, Shamshuipo, Kowloon.

Tel. No.: 2333 0096,Fax no.: 2333 3355

------(For Office Use Only)------

Member Category: LifeMember No.:______

Date Received:______Amount:______Receipt No.:______

Cheque Number:______Date Deposited:______

Membership valid from______to31-12-2099

Date Processed:______

* For new members, “Date of joining” = “Date Received”

Membership Application Form - Life20120803Draft 2