The University of Hong Kong Medical Alumni Association

02/2018

The University of Hong Kong Medical Alumni Association

5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong

Tel: 39179459Fax: 2974 0678Website:

Membership Application Form

* Please delete as appropriate.

Name in English / Professor / Dr / Mr / Miss / Ms / Mrs * / PHOTO
Name in Chinese / Gender / M / F *
HKID/ Passport* / Date of Birth / DD / MM / YYYY
Home Address
Office Address
Phone No. / (Home) / (Office) / (Mobile/Pager)
E-mail / Fax No
Degree(s) of Curriculum / Year of Graduation
Area(s) of Specialty
Category / □Graduate Member / □Staff Member / □Associate Member / □Student Member
Membership Fee / □Life member ($5,000) / □Ordinary member ($500 annual) / □Overseas member ($1,000)
Fee for HKUL graduate borrower’s card*
(applicable to Life Members only) / □Refundable deposit ($1,000) (Deposit is waived for BEA Graduate Credit Cardholders)
□Cost recovery fee ($50) (Cost recovery fee is waived for IHP Membership Cardholders)
* Only Life Members are eligible to submit simultaneous application for graduate borrower’s card of the University of Hong Kong Libraries (HKUL)
Payment Method / □Cheque
(Submit a cheque for membership fee, payable to “The University of Hong Kong Medical Alumni Association”.) / □Paypal
(A payment request email will be sent toyouremail address upon receipt of your application form. Click "Pay Now" in the email and you will be directed to PayPal page to make the payment online by credit card.)
Simultaneous Membership Application(# applicable to Life Members only)
□ / # I opt for simultaneous application for a graduate borrower’s card of the University of Hong Kong Libraries (HKUL) and agree to observe the Library Regulations currently in force. I agree and authorize the University of Hong Kong Medical Alumni Association (the Association) to pass my personal data provided above onto HKUL for card application and further communication purposes.
I wish to receive information including news, events, call for participation, and other HKUL related activities. Yes  No
□ / # I opt for simultaneous application for ordinary membership of the Hong KongUniversity Alumni Association (HKUAA) which is FREE of charge. I agree and authorize the Association to pass my personal data provided above onto HKUAA for membership application and further communication purposes.

□ I understand and agree the personal data provided above can be used by

1. the Association for furtherance of the objectives stipulated in the Memorandum of Association;
2. the Association for internal communication purposes;
3. the University of Hong Kong for communication with graduates; and
4. the University of Hong Kong Libraries (HKUL) for purposes related to the use of HKUL services in accordance with the HKUL’s Personal Information Collection Statement at if I have opted for simultaneous application for a graduate borrower’s card of HKUL.

Date: / ______/ Signature: / ______
Office use only
Membership Fee: / Cheque No.:
Membership No. Assigned: / Transaction Date:
Temporary Card sent: / Membership card sent:

Receipt No:

The University of Hong Kong Medical Alumni Association

Guidelines for Membership Application

Membership Category
Graduate Member
This type of membership is open to all MBBS or MD graduates of The University of Hong Kong (HKU). A graduate member is a voting member who has the right to elect the Executive Committee, hold office, attend and vote at any general meeting.
Staff Member
This type of membership is open to all current HKU full time teaching and / or research staff of the Faculty of Medicine who are not medical graduates of HKU. A staff member is a voting member.
Associate Member
This type of membership is open to all graduates of other degree courses of the Faculty of Medicine of HKU, or past teaching, research, administrative and/or clerical staff of the Faculty of Medicine of HKU. An associate member is not a voting member.
Student Member
This type of membership is open to all HKU students at or above the third year of the medical curriculum of the Faculty of Medicine. A student member may enjoy all privileges of membership except free parking at Faculty of Medicine Building since this privilege is aimed to facilitate alumni members to visit the campus. A student member is not a voting member.
Membership Fee
Entrance fee / Subscription fee
Graduate member
Life member / Free / HK$5,000
Ordinary member* / Free / HK$500 (Annual)
Overseas member** / HK$1,000 / Free
Ordinary member /overseas member converted to life member / N/A / HK$4,500
First three years after obtaining MBBS degree / Free / Free
Staff/Associate member
Life member / Free / HK$5,000
Ordinary member / Free / HK$500 (Annual)
Student member / Free / Free
* The membership year is from September 1 to the August 31 next year.
** Overseas members should be eligible for Graduate members and have resided away from Hong Kong over one year.
Application Method
Fill out the application form and submit with a passport-size colour photo (print or digital file) for membership card, and mail toHKUMAA, 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, HK; or email to .
A temporary membership card will be sent to you after receiving your application. You will receive the permanent membership card in about 3 months.
Payment Method
By Cheque: Submit a cheque for membership fee, payable to “The University of Hong Kong Medical Alumni Association”; or
By Paypal: Upon the receipt of your application form, a payment request email will be sent to the email address provided. Click “Pay Now” in the email and you will be directed to PayPal page to make the payment online by credit card.
Members’ Privileges
Free Parking at Faculty of MedicineBuilding
Presenting your membership card can enjoy a maximum of 3-hour free parking per day.
Caltex StarCard - HK$1.8 off on every litre of gasoline and $3.4 off on every litre of diesel purchased
Subscription for a Caltex StarCard with our membership card offers you the discount.
Free access to Alumni Chamber
Free access to and advance booking of Alumni Chamber with your membership card.
Enquiry
Secretariat, The University of Hong Kong Medical Alumni Association
Address: 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, HK
Telephone: 39179459 Fax: 2974 0678 Email: Website:

HONGKONGUNIVERSITYALUMNI ASSOCIATION

香 港 大 學 校 友 會

Room 101, 1/F, YipFungBuilding, 2 D’Aguilar Street, Central, Hong Kong

Tel: 2522 7968, 2523 0789 Membership Service: 3421 1218 Fax: (852)2523 2660

Email: Website:

Ordinary Membership Application

HKUAA is currently collaborating with HKUMAA on a simultaneous membership registration. In this regard, I hereby submit my application for Ordinary Membership for Hong Kong University Alumni Association (HKUAA). My personal details are enclosed overleaf and I agree and authorize the Association to use my personal data in my present Membership Application.

Terms & Condition

□I, the undersigned, hereby authorize HKUAA to confirm my personal details with relevant party (parties) for the purpose of this application and I hereby agree to be bound by the Memorandum and Articles of Association and the bye-laws of the Association.I acknowledge that HKUAA reserves all rights to make ultimate decision on all membership application related decisions as well as amending any terms & conditions without prior notice.

□I, the undersigned, hereby declare that the information provided therein is true, accurate and up-to-date.

Signature: / ______
HKID Card / HKU no: / ______

The HKUAA Clubhouse is a popular dining, wining and meeting place for members conveniently situated at 1/F, YipFungBuilding, 2 D'Aguilar Street, Central with a net area of about 3,300 sq. ft. You can access the facilities offered by HKUAA by registering as their members. Free membership is now offered to all HKU graduates.

HONGKONGUNIVERSITYALUMNI ASSOCIATION

香 港 大 學 校 友 會

Room 101, 1/F, Yip Fung Building, 2 D’Aguilar Street, Central, Hong Kong

Tel: 2522 7968, 2523 0789 Membership Service: 3421 1218 Fax: (852)2523 2660

Email: Website:

Guidelines for Membership Application

Kinds of Membership / Entrance Fee / Subscription Fee / Requirements
Ordinary Member / Free / Nil /

• Graduates of the University of Hong Kong and Past Students
• Registered as internal students of the University.

Student Member / Free / Nil /

• Full-time & Part-timestudents

Life Member / $9,000 / Nil /

• Upon payment of the relevant fees and subject to the approval of the Executive Committee.
• Life Members may enjoy certain privileges as determined from time to time by the Executive Committee.

Associate Member / Free / Nil /

• Past and present members of the Court, Council and HKU Foundation (in propria persona) and Term 1 and Term 2 and/or Bands B-J staff of the University of Hong Kong.

Subscribing Member / $3,000 / $2,400 p.a. /

• Any respectable permanent resident of Hong Kong having the interests and welfare of the Association at heart
• Upon payment of the relevant fees and subject to the approval of the Executive Committee.

Associate Life Member
- less the amount of entrance fee
- paid on enrollment as Associate Member / $18,000 / Nil /

• Any Associate Member or person upon payment of the relevant fees subject to the approval of the Executive Committee.
• May enjoy certain privileges as determined from time to time by the Executive Committee.