UseofFitnessRoomFacilities使用健身室-InstituteofHuman.doc

THE UNIVERSITY OF HONG KONG INSTITUTE OF HUMAN PERFORMANCE Application for the Use of University Sports Facilities (TOS III or VIII and Fixed-Term Band A) Please read the notes overleaf and then fill in the details as below: Section A1) Personal Particulars of Principal Member (HKU Staff): Name of University Appointee (Mr/Ms):_________________________________________________________________________ (Exactly as it is printed on Staff Card) HKID/Passport No: ______________________________________ Staff number: _________________________________________ Department/Unit: ________________________________________ Position held: _________________________________________ Retirement or Contract End-date: _________________________________________________________________________________ Contact Tele No.: (852)____________________________________ Email: ______________________________________________ Section A2) Family members’ personal particulars [If you would like to include your family members (spouse and children aged 2-24 only) to join the membership, please fill in their details in the space provided below as appropriate.] Name (as recorded in the University’s HRS record) Application Type (Please circle as appropriate) HKID Card / Passport No. Age Date of Birth (dd/mm/yyyy) Facility Access Card (FAC) No. (if applicable) For IHP’s use only Spouse New / Renewal Child New / Renewal Child New / Renewal Section B: Payment B1) Fee Amount: Please refer to the fee table overleaf for details. B2) Please fill in number of total number of Applicants if appropriate ( Applicant without Staff Card or FAC Total number: ____________ x HK$50@ = ______________________ ( Staff cardholder/FAC holder Total number: ______________________________________________ B3) Payment Method: The required membership fee and the relevant card fee of HK$50 for the first issuance of EACH FAC will be deducted from the principal member’s salary.