Summer [email protected] 2017 Registration Form

Please complete and return the “Registration Form”, together with payment for registration fees, .... (name of participant aged below 18) to participate in the.
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Summer [email protected] 2017 Registration Form Important Notes 1. Please complete and return the “Registration Form”, together with payment for registration fees, to The Hong Kong Polytechnic University. Address: Alumni Affairs and Development Office, Room M1504, 15/F Li Ka Shing Tower, The Hong Kong Polytechnic University, Hung Hom, Kowloon. Email: [email protected] Enquiry Tel. No.: 2766-4102 Fax No.: 2954-0315 2. Registrations received without payment will not be processed. 3. Confirmation emails will be sent to successful registrants prior to the activity. Registration fee is non-refundable once the registration is accepted. 4. Each alumnus can bring a maximum of 2 children to join each programme. The parents/guardians of participants aged below 18 must sign the “Parent/Guardian Authorization Form”. If any participants fail to submit this form, the organisers reserve the right to refuse him/her from participating in the activities. Programmes for Registration Please  as appropriate

Registration fee

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HK$70 (adult) HK$50 (age 8 – 17)

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HK$150 (adult) HK$100 (age 12 – 17) (include transportation and travel insurance) HK$180 (adult) HK$150 (age 12 – 17) (include transportation and travel insurance) HK$70 (adult) HK$50 (age 10 – 17)

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22 July (Sat) 10:00am – 12:30pm Anti-Mosquito Sachet Workshop & Guided Tour to PolyU’s House of Innovation 29 July (Sat) 8:00am – 2:00pm Hong Kong Fishermen Culture & Eco Tour – Northeast New Territories [mangrove site, mariculture raft and demonstration on fishing methods] 12 August (Sat) 8:30am – 1:00pm Low Carbon Diet Workshop @ Green Hub [harvest seasonal herbs, interactive activities such as food preparation and post-meal waste treatment, heritage tour] 19 August (Sat) 10:00am – 12:30pm Upcycling Artwork Workshop & Guided Tour to PolyU’s Eco-friendly Facilities [transform unused waste to handicraft artwork, campus guide tour]

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Total HK$ 0.00 Disclaimer: I/ We would like to join the “Summer [email protected] 2017” programmes, and declare that: I/ We will follow all the rules and arrangement imposed by the event organizers on the programmes. I/ We confirm that I am / we are suitable for the activity and will bear all the responsibilities, including deaths, injuries, or loss of properties caused by any accidents or incidents during the programmes. No organizer(s), co-organizer(s), sponsor(s) or supporting organization(s) or their working staff have to compensate for the deaths, injuries, or loss of properties caused by any accidents or incidents during the programmes. Participant (Alumni) 1st Child 2nd Child Name (Eng) Name (Chi) Age Graduation Year Graduation Department Mobile Phone No Email address Emergency Contact Person/ Phone No. Signature Payment Method Please  as appropriate By Cheque (Please make the cheque payable to “The Hong Kong Polytechnic University”) Signature By Credit Card PolyU Visa Card VISA MasterCard Name of Card Holder Amount HK$ 0 Card Number Expiry Date (MM/YY) Personal Information Collection Statement To ensure that you are informed of PolyU’s latest developments, we will send news and announcements of the University (and its internal departments and constituent units) and other information (including information about activities, benefits and services, education programmes and solicitation of donations) to you through various communication channels by using your personal data provided (including email address, mailing address, contact telephone number and fax number). We will not use your personal data for sending the said information to you without your consent, and if you want to have access to or change your personal data, please contact the Alumni Affairs and Development Office of PolyU at Tel: (852) 2766 4102/ Fax: (852) 2945 0315/ Email: [email protected] If you do not agree to our use of your personal data for the above-mentioned purposes, please let us know