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Membership Information Form

 

 

 

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: ___________________

 

******************************************************************************

 

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  ________________________

 


ĉ
HKU AASC,
Apr 28, 2010, 8:45 AM
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