TNAG-2446-FCO40-3562-Political-parties-in-Hong-Kong-1992 — Page 45

請以膠水封口

香港民主會會員申請表

Hong Kong Democratic Foundation Membership Application Form

I. PERSONAL 個人資料

VI. COMMUNITY SERVICES EXPERIENCE

社會服務經驗

Surname

中文姓舀

Name in Chinese

姓別

红

Sex MUJ F[]

谢姻狀況

Marital Status SL

未婚

已婚

ML

否

Chinese YO NUJ

舀

Given Name

Iratial

出生年份

Year of Birth

Nationality

居港年期

Years in HK

学院

Period

組織

Organization

職位

主要瞋藏

Position

Major Duties

VII. COMMITTEE WORK INTERESTS

有志參與的委員會工作

Policy Committee

II. CORRESPONDENCE INFORMATION 通訊資料

Membership Committee

幾

古

Company Name

福位

Position Title

Self Employed

YOU

NU

Election Committee

瞬慧

Occupation

Office Address

糈委齉戳

Finance Committee

Public Relations Committee

VIII.MISCELLANEOUS 其它資料

疑

否

Office Tel

Ollice Fax

Other No

Do you want your name shown in members list ?

YLJ

NU

打宅地址

瞧

Home Address

住宅電話

住宅

拜它媽

Do you want HKDF information sent to you by fax or mail?

徽下附帶套鳙的卤料感封住宅或公司?

F}

MU

住宅

公司

Home Tel

Home Fax

III. EDUCATION LEVEL 教育程度

Other No

Do you want HKDF information sent to your home or office?

閣下如何認識縻識?(請在邋襻爛肉加上剔號)

OLI

IV. LANGUAGE SPOKEN 能操語言

V. AFFILIATION 社團聯繫

谢祭鹣

Professional Bodies

How do you know HKDF (please lick your choice)

Introduced by a friend A AM

2 Through HKDF advertisement 4✯☎! E

3 Direct Mailing – 11 18 48%

4 Other C

(please specily) A

IX. MEMBERSHIP FEE 會費

! Il nave enclosed a HK$200 cheque (regular members) or HK$50 (full me students or

those who are 60 or above) payable to the Hong Kong Democratic Foundation

Commercial Boxes

Ill prefer to pay by CREDIT CARD I understand that my membership lee will be charged

to my VISA/MASTERCARD/OTB CARD account

转蚁。

"Social Boches

契

Political Bodies

Card No

Signature

Expiry Date

到期归子

Total Amount 金雞戳

*Signature should correspond to that of your credit card account (RAEGU AUT

X. DONATIONS 捐款

(Please make cheque payable to 'Hong Kong Democratic Foundation"袁興勤維請能

Other

No, I do not wish to join the Hong Kong Democratic Foundation at this stage but i would like to give a donation of

LJ HK$50,000

[] HK$1,000

13HK$10,000

LJ HK$500

1) HK$5.000

Others

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