HKCS Membership Upgrade Application Form

1. I hereby apply for a:*

Fellow Member Full Member Associate Member General Member

2. I shall* another class of membership if I am not qualified for the class which I apply.

3.Membership Number:*

PART I PERSONAL PARTICULARS

(Please indicate your name as shown on the HKID Card or other identification documents)

Salutation

Title

Family Name*

Given Name*

Chinese Name

Nationality

Sex*

Date of Birth*

HKID Card / Passport No.*

( )

Residential Address

Residential Tel. No.

Residential Fax No.

Mobile Phone No.*

Personal E-mail*

Alternative Email

Correspondence Postal Address

PART II CURRENT EMPLOYMENT DETAILS

Name of Company / Organization*

Industry Code

Office Address

Job Position*

Job Level

Job Nature Code

Office Tel. No.

Office Email

Unemployed / Unavailable / Career in transition

* - Fields marked with asterisk are mandatory

PART III ACADEMIC QUALIFICATIONS (Please provide information in reverse chronological order)

Level of Qualification (e.g. Bachelor/Master)*	Subject Area (e.g. Science/Business)*	Major (e.g. Computer Science/Computer Engineering)*	University / Institute / College*	Country*	Date Attained (YYYY//MM/DD)*	Action

PART IV PROFESSIONAL QUALIFICATIONS

Professional Qualification	Date Attained (YYYY/MM/DD)	Professional Body	Action

PART V COMMUNITY SERVICES / OTHER MEMBERSHIP

Name of Organization	Membership Grade	Position / Membership no.	From YY/MM	To YY/MM	Action
				Current

PART VI EMPLOYMENT HISTORY

(Please provide information in reverse chronological order.)

From (YY/MM)*	To (YY/MM)* End date or Current	Main Responsibilities*	Referee	Name of Company / Organization*	Job Position*	Referee Contact No.	Referee e-mail Address	Actions
	Current			Same as Part II	Same as Part II

Total Years of IT Experience*

PART VII REFERENCE (For upgrade to Fellow Member Only)

Please use separate sheet of paper if necessary

PART VIII REFERENCE (For upgrade to Fellow Member Only)

Name	HKCS Membership No.	Contact No.	Email address

Note: Application for Fellow membership requires support by two Distinguished Fellows or Fellows members of HKCS.

PART IX DECLARATION

1. I declare that the information given in this form and any other documents submitted together are true and correct. I understand that willful false declaration will render me liable to disqualification for membership by the Society or termination of membership, if already admitted by the Society.
2. I hereby authorize Hong Kong Computer Society to conduct background check with my current and previous employers, referees and educational institutes which I attended as the Society’s deem reasonable and appropriate.
3. If admitted to the Society, I undertake to be bound by the Constitution of the Society, as amended from time to time.
4. I understand that the Membership Committee of the Society reserves the right to approve or reject the membership application of any individual.
5. In an ongoing effort to enhance members' recognition and communication, I understand my data will be put in HKCS membership registry on HKCS website and HKCS Members handbook. This registry/handbook will list the name, member category and joining date of member.

Date

Signature of Application

Or upload signature image: Choose File No file chosen

PART X PERSONAL DATA (PRIVACY) NOTICE - USE OF PERSONAL DATA

People who supply data in their application to the Hong Kong Computer Society are advised to note the following points, pursuant to the Personal Data (Privacy) Ordinance:
1. Personal data provided in this application form will, during the entire process, be used solely for this purpose, and in this connection, the data will be handled by the Society’s staff or by any Council members of the Society who is directly involved in the administration of this application.
2. Applicants are advised to provide all the information requested in the relevant documents, where applicable, failing which the Society may be unable to process and consider their applications.
3. After the applications have been processed and the relevant exercise completed: (a) the information collected from unsuccessful candidates will be destroyed; (b) the application papers of successful candidates will become part of the file which the Society opens for each member.
4. Under the provisions of the Personal Data (Privacy) Ordinance, applicants have rights to request access to, and to request the correction of, their personal data. Applicants wishing to access or make corrections to their data should submit written requests to the Director of Membership Services & Administration of the Hong Kong Computer Society.
Declaration:
1. I have noted the general points pursuant to the Personal Data (Privacy) Ordinance.
2. I authorize the Hong Kong Computer Society or any other office that is directly involved in the administration of this application to use, check and process my data as required for my application.

Date

Signature of Application

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**If you are returning your application form by email and are unable to sign, please tick the box below to indicate your agreement to the declaration:

I agree to the above declaration of PART VIII and PART IX