所有糖尿病患者及其家庭均可成為會員。 我們亦誠邀所有熱心人士申請為附屬會員 ,為糖尿病童出一分力,改善他們的生活及未來。 會費全免。 會員可以會員價優先參加本會舉辦的活動、定期獲取本會的會員通訊、享用醫療公司提供的獨家訂購及試用優惠等。請聯絡我們 2544 3263 YDA Membership Form 申請入會表格 Type of membership 會員類別* Young Member 青少年會員 Age under 18/ 18歲以下 Adult Member 成年會員Age 18 or above/ 18歲以上 Applicant's infomation 個人資料Name 姓名*English中文 (type 'No' if not applicable)Gender 性別* Male 男 Female 女 Date of birth 出生日期*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920HKID 身份證*Require only the first 4 digits. 只需頭4個字元。Mobile no 聯絡電話*Email address 電郵* All communications will be by email. 所有通訊會經電郵處理。Address 地址* Flat, Floor, Block, Building 單位、樓層及大廈名稱 Street name 街名 Village/Town/District 村/鎮/區 Region 地區 Name of school (if applicable) 學校名稱 (如適用)Occupation/Job title 職業/職稱Company/Organisation 公司/組織Type of diabetes 糖尿病類型* Type 1 一型 Type 2 二型 Others 其他 Month & year of diagnosis 確診年份及月份*Follow up hospital 覆診醫院*AHMLNH 大埔那打素醫院CH 兒童醫院CMC 明愛醫院KWH 廣華醫院PMH 瑪嘉烈醫院POH 博愛醫院PWH 威爾斯醫院PYNEH 東區醫院QEH 伊利沙伯醫院QMH 瑪麗醫院TKOH 將軍澳醫院TMH 屯門醫院UCH 聯合醫院Other 其他如選“其他",請注明覆診醫院或診所*Please specify follow-up clinic if “Other” was chosenFamily member information 家庭會員資料For Young Member only, at least 1 Family Member needed. 只供青少年會員填寫,必須申請最少一名家庭會員。Primary Caregiver 主要照顧者Name 姓名*(English) SurnameGiven Name(中)Contact no 聯絡電話*Relationship 關係*Email address 電郵地址* Secondary Caregiver (Optional) 次要照顧者 (可選填)Name 姓名(English) SurnameGiven Name(中)Contact no 聯絡電話Relationship 關係Email address 電郵地址 Others 其他I would like to contribute to the following volunteer work本人願意參與以下義務工作Optional for those with established diabetes Provide peer support 提供同儕支援 Support member’s event 參與會員活動 Write article 撰寫文章 Fundraising 募捐 Others 其他 (Please specify請註明) Others 其他 (Please specify請註明)Method of communications 通訊方法* English 英文 Chinese 中文 Preferred language 通訊語言Publications and Promotion Materials received by 機構刊物及宣傳單張收取方法* Email 電郵 (Be environmental friendly 請支持環保,減少用紙) Post 郵寄 Declaration 聲明* I have read and agreed with the statements below (Parents please check on behalf of applicants under 18)我已閱讀並同意以下聲明(家長請代十八歲以下的申請者核對)a. Information provided must be true and complete. 填報之資料必須正確無誤。 b. In accordance with Personal Data (Privacy) Ordinance, all personal data collected will be kept confidential. The applicant has the right to request access to and corrections of any of the personal data provided. The applicant who wishes to obtain copies of the personal data will be subject to administrative charges. Any request should be made in writing and addressed to the Executive Director of Youth Diabetes Action (YDA). 本會使用個人資料的程序均遵照《個人資料(私隱)條例》的規定,所收集的個人資料將保密處理。申請人提交的一切資料概不發還。不過,根據個人資料私隱條例,申請人有權查閱及更正申請表內填寫的個人資料。此外,申請人亦可索取個人資料的副本,但須付有關的行政費用。此項要求須以書面型式向本會總幹事提出。 c. Authorization of use of pictures: Youth Diabetes Action has the right to take pictures at all YDA’s activities; to use and/or publish the pictures to the publications and/or website of YDA. 攝影授權:本會有權於本會活動中拍攝照片,而有關相片可在印刷品或電子媒體上使用。 d. Disclaimer: Members who participated in YDA activities should bear their own risk and YDA is not responsible for any loss, damage or injury resulting from the activities. 免責聲明:參加本會活動的參加者須承擔一切風險。兒童糖尿協會不會為任何參加者或其家庭作出任可賠償。 Purpose of collection and guideline for use of personal data 收集資料目的及使用準則 – Youth Diabetes Action (YDA) will use personal data collected from data subject for the purposes for which it was collected. 兒童糖尿協會將依照在收集資料時所說明之目的使用該等資料。 – To provide personal data to YDA is on voluntary basis. However, if you do not provide sufficient personal data, we may not be able to process your application or provide service to you. 向本會提供個人資料純屬自願,如你未能提供足夠個人資料,本會可能無法有效處理你的申請或提供有關服務。 – YDA may use your personal data in future (name, telephone number, fax number, email, mailing addresses) for the purposes of providing you with information of the Association, handling application, issuing receipt, research, fundraising appeal, collecting feedbacks, activities invitation/ promotion purposes, and notifying programmes of the Association. 本會可能使用你的個人資料 (包括你的姓名、電話、傳真、電郵、郵寄地址),以便本會日後與你通訊、處理報名、發行收據、研究/分析/统計、籌款、收集意見、作活動邀請/推廣用途,及與本會相關之項目事宜。 Access to and correction of personal data and request for cessation of using personal data for promotion purposes 查閱及更新個人資料及申請停止使用個人資料作推廣之用途 Apart from the exemptions provided under the Personal Data (Privacy) Ordinance, you are entitled to access and correct your personal data held by Youth Diabetes Action, and request us to cease to use your personal data for promotion purposes. However, it will not include the personal data deleted after the achievement of the purpose. 除了《個人資料(私隱)條例》規定的豁免範圍外,你有權就兒童糖尿協會備存有關你的個人資料作出查閱、更改及停止使用你的個人資料作推廣用途的要求,但已達成使用目的後而刪除的個人資料除外。