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Mr. /Ms. ______________________________________ Chinese Name:___________________ Faculty & Hall at HKU if applicable: _________________________________________________
Degree & year of graduation if applicable :____________________________________________
Address (H): ___________________________________________________________________
Tel. (H): _________________________________ Fax: ____________________________
Tel. (Cell): _______________________________ E-mail : _________________________
Profession: _______________________________ Title: ___________________________
Company: ________________________________ Tel. (W): ________________________
Address (W): __________________________________________________________________
Spouse: _____________________________________ Chinese Name: ___________________
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I would like to serve on the following committee(s): [ ] Membership [ ] Program [ ] Mentorship [ ] Website [ ] Scholarship Membership:
[ ] Ordinary – annual subscription waived [ ] Life – one time subscription $250 [ ] Associate – annual subscription $25 Membership Information Form and check, if applicable, payable to HKUAASC to be mailed to
P.O. Box 1418, San Gabriel, CA 91778
Signature ____________________________ Date ________________________
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