Hong Kong Occupational Therapy Association

HONG KONG REMOTIVATION THERAPY ASSOCIATION APPLICATION OF MEMBERSHIP (20____-20____)

Name: Dr. / Mrs. / Miss / Ms. / Mr.* (English) (Chinese) Name of Working Place: HKID/ Passport No.: ______Nature of Work:  Hospital Authority  Non-Government Organization  Civil Servant: SWD / DH /  Private Practice  Academic Institute  Others, Please Specify: Tel. No.: (Office) (Home): (Mobile):

Mailing Address (Please use block letters):

______

E-mail address (major mode for communication):

QUALIFICATIONS: RT Qualification: Level Year of graduation: Name of RT Institution: Highest academic qualification: Year obtained: Name of Academic Institution:

APPLICATION OF MEMBERSHIP: (please  in the appropriate box)

Category of Type Subscription fee Sub- Membership [note 3] (Membership year starts from 1 Total August) 1 year 3 year Full member [note 2] Life ------$ 800 New $ 100 $ 250 $ Renewal within grace period [note 1.2] $ 100 $ 250 $ (Previous membership No: ) Total $

Student Member New/Renewal $ 50 ------$ Transferring from (Previous membership No: ) $ 70 $ 175 $ student member to full member Associate Member New/Renewal $ 50 ------$ Total $ I enclose herewith:  Photocopy of Remotivation Therapy certificate (for new or associate member application)  Photocopy of Attendance certificate (for student member application)  Others: ______ Crossed cheque No. : Bank : Cheque should be made payable to Hong Kong Remotivation Therapy Association and be mailed to

John LEE Occupational Therapy Department, 1/F., Kwai Chung Hospital, 3-15 Kwai Chung Hospital Road, Kwai Chung, N.T.

Signature : Date:

For Official Use Only Credential Checked : Membership Card No. : Date : P.T.O. Relevant notes on Membership

1. Membership year 1.1 A membership year will subsist from 1 st August to 3 1 st July of the subsequent year. 1.2 To facilitate renewal of membership of existing members, there is a discretionary grace period of around 3 months, i.e. from 1st August to 31st October of the year of expiry of membership, for existing members to complete renewing their memberships. Failing to comply with such time limits will be treated as New application of membership and New membership fee will be applied. 2. Membership Tenures

Memberships Tenures Life Full member Lifetime Full member 1 or 3 years Associate/Student member 1 year 3. Benefits of members

Memberships Benefits Life Full member - having voting rights / Full member - qualified to use RT related material published by HKRMTA - receiving updated news/ RT related resources and/or newsletter of HKRMTA in the future - enjoying priorities in attending course organized by HKRMTA and may enjoy discount in relevant course fees Associate/student - receiving newsletters of HKRMTA in the future member - enjoying priorities in attending course organized by HKRMTA and may enjoy discount in relevant course fees 4. Members’ responsibilities Member shall 4.1 comply to the Constitution of the Hong Kong Remotivation Therapy Association 4.2 update HKRMTA on his/her current particulars, i.e. e-mail address and telephone number, etc. whenever there is/are change(s), to facilitate effective communication 4.3 keep the membership card in good condition and return the same to HKRMTA forthwith whenever it is requested 4.4 show to HKRMTA’s representative(s) his/her membership card for identity of membership in any event 5. Mode of communication 5.1 HKRTA will communicate with its members by e-mail 5.2 Relevant information including constitution of HKRTA, course information and relevant meeting information, etc. can be seen in the website: (launches later) 6. Notice to Data Subject Regarding Personal Data Disclosed The personal data provided by you will be accessible only to those persons who are directly involved in the operation of the Association. They are required to observe the rule of confidentiality under the Personal Data (Privacy) Ordinance and other relevant ordinances. Personal data are only disclosed when the Association Council authorizes such disclosure. You have right of access to and correction of personal data held on you by the Association. Your right of access includes the right to obtain a copy of your personal data which may subject to payment of a fee as prescribed by the Association Council. (MAY2012)