Application for Life Membership of Hong Kong PolyU (United Kingdom) Association Part a – Personal Particulars



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Please print and fill this form and post it to Hong Kong PolyU (United Kingdom) Association:

c/o Stephen Yau, 53 Apsley Way, Peterborough PE3 9NZ, United Kingdom or email to alumni@polyu.edu.hk
To: Hong Kong PolyU (United Kingdom) Association
Application for Life Membership of

Hong Kong PolyU (United Kingdom) Association
Part A – Personal Particulars

Surname:




First Name:




Address:







Home Tel:




Office Tel:




Email:




Occupation:

Management Accountant

Connection with The Hong Kong Polytechnic University or its forerunners:

(please mark as appropriate or copy and paste)




Period




Department

Course of Study / Position

Alumus

Former staff



From


To







Alumus

Former staff



From

To







Alumus

Former staff



From

To







Alumus

Former staff



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Part B
I, __________________(Full Name of Applicant), hereby apply to become a life member of the Association and request you to enter my name in the Register of Members accordingly subject to the Articles of Association.

In the event of my admission as a member, I agree to be bound by the rules of the Association



for the time being in force.
___________________________

(Signature of Applicant)

___________________________

(Date)
Thank you very much for your application.

Hong Kong PolyU (United Kingdom) Association Registered in ENGLAND & WALES Registered Number: 07168258 Registered Address: 14 St Georges Tower, St Georges Place, Cheltenham GL50 3PW Email: alumni@polyu.edu.hk


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