The University of Hong Kong s7

COMMUNITY MEMBERSHIP Date of receipt: ______(1016H27) THE UNIVERSITY OF HONG KONG Centre for Sports and Exercise Application for the use of University Sports Facilities: Community Membership Please read the notes overleaf thoroughly. The completed form (please print or write in English clearly) should be returned to Flora Ho Sports Centre, 111-113 Pokfulam Road, Pokfulam, Hong Kong together with required documents stated overleaf Section A1) Personal Particulars of Principal Member Application Type: New Application / Renewal (Please circle as appropriate) Name: *Mr/Ms:______Chinese Name if applicable: ______(exactly as it is printed on your HKID card/Passport) HKU Facilities Access Card (FAC) No. or HKID Card /Passport No: ______Membership No. (if applicable): ______Mailing Address: ______Contact Phone No: (852-) ______E-mail: ______Name of Employer: ______Position: ______Section A2) Family Members’ Personal Particulars [If you wish to include your family members (spouse and children) to join the membership, please fill in their details in the space provided below as appropriate.) Name Facility Access Card / Application Type HKID Card / Date of Birth (exactly as it is printed on HKID (Please circle as Age Membership No. For CSE’s use only Passport No. (dd/mm/yyyy) card / passport) appropriate) (if applicable) Spouse New / Renewal Child New / Renewal Child New / Renewal Section B1) Fee Amount – Please refer to the following Membership Fee Payment (subject to annual review): Annual Fee No. of First FAC issuance fee# Category Sub-Total (HK$) Applicant(s) (for new applicants only) Family (Principal + Spouse & 2 Children aged 2-18) $16,720 $50@ x ___ cards Adult / Senior Child aged 19 or above $6,050 x $50@ x ___ card(s) + = Child aged 2-18 $5,280 x $50@ x ___ card(s) Unreturned Laminated Membership Card if applicable $150 / each x --- Total: #New applicants will be subject to the first issuance fee of HKU Facilities Access Card (FAC) at $50 each. Renewal applicants do not need to pay the first issuance fee of FAC but are still subject to any unreturned laminated membership card fee / replacement card fee if applicable. Section B2) Payment Methods The required membership fee should be paid by cheque made payable to “THE UNIVERSITY OF HONG KONG” (Please put down principal member’s contact phone numbers and FAC number / Laminated membership card number whichever is applicable on the back of the cheque).

Issuing bank: ______Cheque no: ______Total (HK$): ______Section B3) Duration of Membership The membership duration for the principal member and their family is on a 12-month basis from the month of membership issued or at CSE’s discretion subject to the required fee payment as above-mentioned. The duration of their family membership will be the same as that of the principal member (please note that the application processing time will be included in the membership period.). The relevant membership fee of family membership with a duration less than 12 months (subject to CSE’s approval) will be charged on a monthly pro-rata basis, rounded up to the nearest HK$5. All fees are non- refundable in the case of any membership withdrawal or termination by the CSE. Section C: Declaration I have read the conditions overleaf and confirm my acceptance of them, and hereby apply for use of the CSE sports facilities as Community Member(s) and herewith enclose the required annual membership fee. I also hereby affirm that I/my family members am/are in good physical condition to partake in physical activities and/or exercise. My/Our participation is purely voluntary and in no way mandated by The University of Hong Kong. I/We also understand that I/we should monitor my/our own condition throughout exercise/physical activities. I/We should stop the activity or exercising anytime if I/we have any discomfort or even without any particular reason. In no event shall The University of Hong Kong, its officers, employees, or agents be held liable for any injury, death, or property loss which I/we may suffer during the activities if caused by either my/our own negligence, inadequacies in health and fitness or by accident. I / my family members also agree to follow the rules and regulations of the CSE. I assume liability for all damage on the equipment/facilities used by me / my family members that are caused by myself / themselves due to improper use or non-observance of the CSE’s rules and regulations.

I / my family member shall at all times behave in a decorous manner within the sports facilities, and shall cooperate with the staff of the CSE to ensure that these Regulations and any subsidiary rules laid down by the Committee of Management are adhered to. I understand the Director and his/her delegated appointee(s) shall have the authority (i) to request any user to leave the sports facilities, or to cancel their sports membership; or (ii) to suspend temporarily user privileges, for infringement of these Regulations or subsidiary rules and the Director has the authority to debar any users or persons from using the facilities and/or other user privileges either temporarily or indefinitely.

Date:______Signature of Principal Member: ______

For CSE’s Use Only Principal’s HKID & FAC Spouse’s and/or Child’s HKID & FAC Marriage Cert. Birth Cert. Address Proof All of the above Verified by: Date: Membership / FAC issued by: ______(Date: ______) LMS inputted by: ______(Date: ______) Remarks: ______

Section D: Eligibility Hong Kong citizen and their direct family members (spouse and children) who hold HKID cards can apply for CSE’s Community Membership. Membership is subject to a quota as laid down and agreed by the CSE’s Committee of Management, and subject to the fulfilment of all of the COMMUNITY MEMBERSHIP Date of receipt: ______(1016H27) following:

 Provide all the required documents as stated in Section F for CSE’s information verification  Compliance with the CSE’s rules and regulations  Payment of the required membership fee  Section E: Entitlement Community Members can use the following CSE facilities at the Flora Ho / Stanley Ho Sports Centres during opening hours subject to availability:  For details on the facilities that Community Members are entitled to book, please refer to our website (Sport  Sports Facilities  Booking  Individual Booking).  Booking entitlement: Timeslots Eligibility 7-day advance booking or on-the-spot off peak times (07:30 to 16:30 on Mon to Fri) o booking o peak times (16:30 to 22:30 on Mon to Fri and all times on Sat, Sun, public / HKU’s 2-hour advance booking or on-the-spot holidays) booking Booking can be made by phone at 2817 3768 / 2819 4427 or in person; - To view sports facilities availability before booking, see http://www.ihp.hku.hk (Sport  Sports Facilities  Booking) - To check facilities closure, see: http://www.ihp.hku.hk (Sport  Sports Facilities  General Information); - Check-in upon arrival is required.  Car parking is subject to availability and CSE’s policy: http://www.ihp.hku.hk (Sport  Sports Facilities  Booking  Car Parking Policy)  Adult members may invite a maximum of 3 guests to use facilities upon paying the stipulated guest fee for each visit / each 1-hour activity session as appropriate as per CSE’s policy: http://www.ihp.hku.hk (Sport  Sports Membership  Guest Policy). Remarks: Child members, aged below 19, should be accompanied with valid CSE adult member(s), are not eligible to make any bookings & bring any guests to use the facilities. Section F: Application Procedures for New Application and Renewal (Application submitted by fax / email will not be accepted) F1) Application Procedures and the Required Processing Time For both new application and membership renewal, applicants should return this application form, duly completed and signed, to Flora Ho Sports Centre (111-113 Pokfulam Road, Pokfulam, Hong Kong) together with the required fee payment and all the required documents stated in Section F2. Normally, the application processing will be completed in 7 working days* (*working days: Mon-Fri, excluding Public / HKU’s holidays) provided that all required documents, photos and the fee payment are received in order. For applications submitted by post, the processing completion time may take 2 to 3 more working days due to the delivery time involved. F2) Required Documents For New Application For Renewal 1. A passport size colour photo taken within the past 6 months of each a. A crossed cheque for the membership fee payment (payable applicant with their names written on the back of the photo. to “The University of Hong Kong) 2. [Postal application]: A photocopy of HKID card / Passport of each b. A photocopy of the existing membership cards. applicant, and a photocopy of Marriage / Birth Certificate (if applicable) as a relationship proof of family members; [In-person application]: c. A photocopy of correspondence address proof (in case of Original copy or photocopy of the aforesaid identity documents of each change of address) applicant for verification on the spot. d. Return of the existing membership laminated membership 3. A crossed cheque for the membership fee payment (payable to “The cards at the time of collecting FAC University of Hong Kong) e. Members are advised to submit renewal application 3-4 weeks 4. A photocopy of correspondence address proof (e.g. mobile phone bill before membership expiry in view of the processing time or utility bill under the Principal Applicant’s name) required. Section G: Membership Collection / Activation Community Members will be issued with the HKU Facility Access Card (FAC) upon approval of their application & completion of the processing (see Section F1). New applicants will be subject to the first issuance fee of FAC at $50@. Renewal applicants do not need to pay the first issuance fee of FAC but is still subject to any unreturned laminated membership card fee / replacement card fee if applicable.

G1) For the new application The principal member can obtain his/her/their family members’ FACs in person at the reception of Flora Ho Sports Centre, 111-113 Pokfulam Road, Pokfulam, Hong Kong during 07:30 – 22:00 on Mondays - Sundays except early closures [please visit http://www.ihp.hku.hk (Sport  Sports Facilities  General Information) for details] upon receiving CSE’s email notification.

G2) For the renewal i) If members have not ever been issued with appropriate FAC by the University’s card issuing system before, they will be issued with new FAC and are advised to collect them in person at the reception of Flora Ho Sports Centre, 111-113 Pokfulam Road, Pokfulam, Hong Kong during 07:30 – 22:00 on Mon - Sun except early closures [please visit http://www.ihp.hku.hk (Sport  Sports Facilities  General Information) for details] upon receiving CSE’s email notification. ii) If the principal member and their family members already have the appropriate FAC, they also can automatically gain access to CSE’s sports facilities with their valid FAC when their renewal application is approved and processed after the required processing time as mentioned in Section F1.

Applicants/Principal member who cannot come in person for new FAC collection, please assign a third party to do so on their behalf by means of an authorization letter attached with a photocopy of the principal member’s HKID card, a print-out of the card-collection email sent by CSE and other required documents as stated therein. For enquiries, please contact us at 28173657 or 28174046.

Section H: Rules and Regulations H1) Admission: Member should present their valid FAC at all times for access to the CSE facilities. The FAC is not transferable. After their membership expiry date or withdrawal of membership or termination by CSE, their FACs will become invalid. H2) Rules & Regulations on Using CSE’s Facilities: For the detailed rules and regulations on using facilities, please visit: http://www.ihp.hku.hk (Sport  Sports Facilities  Rules & Regulation). Please note that unless with the prior approval of the CSE, private teaching / coaching activities are strictly prohibited within the CSE’s facilities, please visit http://www.ihp.hku.hk (Sport  Sports Facilities  Booking  Individual Booking). H3) Use of Fitness Room Facilities: Applicants are advised to visit: http://www.ihp.hku.hk (Sport  Sports Facilities  Fitness Centres) for details on the regulations / instructions on using the fitness room facilities H4) Collection of Personal Date – Statement of Purposes: Applicants please visit: http://www.ihp.hku.hk (Sport  Sports Membership  Collection of Personal Data – Statement of Purposes) for details. COMMUNITY MEMBERSHIP Date of receipt: ______(1016H27)

THE CSE RESERVES THE RIGHT TO ALTER THE TERMS & CONDITIONS OF MEMBERSHIP AT ANY TIME. (Oct 2016)