必須填寫此欄並只可選擇其中一項 Please fill in this section and chose one item only	
A: 個人 Individual □ / B:家庭 Family □	

香港科學館2015年8月8日「穿越時空看天文」半日遊報名表格
Hong Kong Science Museum – 8 August 2015 “Understanding Modern and Ancient Astronomical Instruments” Field Visit Application Form

集合地點Assembly Point:	:	香港科學館大堂Main Lobby, Hong Kong Science Museum	
解散地點Dismissal Point	:	香港科學館Hong Kong Science Museum	
注意事項 Notes:
1.	參加者必須為香港居民並年滿10歲或以上；Participant must be Hong Kong citizen and aged 10 or above.
2.	每位50元（博物館通行證持有人九折優惠，全日制學生、殘疾人士及60歲或以上高齡人士半價優惠）；
HK$50 per person (10% off for Museum Pass holder. Half price for full-time student, people with disabilities and senior citizens aged 60 or above)
3.	成功申請之人士需繳交年齡證明文件副本；Copy of documents for age verification is required for successful applicant.	

A1. 參加者個人資料 Personal Information # 註1 Remark1 (個人參加者必須年滿16歲，如屬16-17歲人士請填寫A2項資料。
Individual participant must be 16 years old. For participant age 16-17, please also fill Part A2.)	
姓名 Name :		出生日期 Date of Birth: 		
流動電話號碼 Mobile No:		電郵 Email :		
						
A2. 家長 / 監護人資料 Particulars of Parent / Guardian # 註1 Remark1	
	
我是上述人士的家長/監護人，並同意上述人士參與是項活動 (參加者屬16 -17歲 )。
I am the parent/guardian of the above-mentioned participant (aged 16-17) and give my consent for him/her to join the activity.	
	
姓名 Name:		* ( 父親 / 母親 / 監護人 )
 ( Father / Mother / Guardian)	

流動電話號碼 Mobile No:		電郵 Email	:		

簽署Signature:　		日期 Date	:		
	
B1. 家庭：最多3人／Family: Maximum 3 persons # 註2 Remark2 (如參加者屬10-15歲人士，需由18歲以上家人/監護人陪同出席活動。　Participant who is 10-15 years old must be attended with family member/guardian aged 18 or above.)	
年滿18歲之家人 / 監護人姓名 
Name of family member /guardian aged 18 or above: 	                                    
	* ( 父親 / 母親 / 家人/ 監護人 )
( Father / Mother / Family member/Guardian)	
流動電話號碼Mobile No:		電郵 Email:		
						
家庭成員姓名 (1) 
Name of family member (1) :	
	出生日期 
Date of Birth:		
						
家庭成員姓名 (2) 
Name of family member (2) :	
	出生日期 
Date of Birth:		
				
B2. 家長 / 監護人資料 Particulars of Parent / Guardian # 註1 Remark1	
	
我是上述人士(10-17歲)的家長/監護人，並同意上述人士參與是項活動。
I am the parent/guardian of the above-mentioned participants (aged 10-17) and give my consent for them to join the activity.	
	
姓名 
Name:		* ( 父親 / 母親 / 監護人 )
 ( Father / Mother / Guardian)	

簽署Signature	:		日期 Date	:		

						
緊急聯絡人 Emergency Contact Person 	
姓名 Name	:		流動電話號碼
Mobile No	:		

＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊
請填妥回郵地址Please fill the correspondence address below
姓名Name		姓名Name	
地址Address		地址Address	

LCS48 (06/2015)								

# 註1：18歲以下的參加者必須由家長/ 監護人簽署。
Remark1: Parental / guardians’ consent and signature are required for participants under 18 years old.
# 註2：參加者須於活動舉行當天年滿10歲。10-15歲人士，需由18歲以上家人/監護人陪同出席活動
Remark2: Participants must be 10 years old on the activity date.  Participant who is 10-15 years old must be attended with family member/guardian aged 18 or above.
*請刪去不適用者Delete as appropriate	

報 名 須 知
1.	申請人必須於截止報名當日或之前將已填妥的報名表格寄抵九龍尖沙咀東部科學館道二號香港科學館，或投入設於館內的報名表格收集箱，請於信封面註明｢半日遊｣。逾期恕不受理，恕不接受電話或傳真報名或留位。本表格所收集的個人資料只作安排活動之用，並會於活動結束後銷毀。
2.	根據個人資料(私隱)條例第18及22條及附表1第6項原則的規定，你有權要求查閱及更改本表格所載的個人資料。如要提出有關要求，請致函香港九龍尖沙咀東部科學館道二號香港科學館或致電2732 3249/2732 3223與本館職員聯絡。
3.	每個申請人/家庭只可就同一日之活動繳交一份申請表格，如遞交多於一份表格將被取消資格。
4.	所有名額將於2015年7月6日以抽籤方式分配，抽籤結果將於2015年7月8日在香港科學館網頁(http://hk.science.museum) 公布；成功申請之人士將收到書面通知繳費詳情。
5.	成功申請之人士須按繳費詳情之指示繳交費用及有效年齡證明文件之副本。未能如期繳交者，當棄權論，名額即由後補名單填補。
6.	若截止報名後仍未額滿，則以「先到先得」形式繼續接受報名。
7.	除活動取消外，已繳費用，概不退還。名額不得轉讓，亦不得將已繳費用申請參加其他活動。
8.	活動主辦單位有權更改活動舉行的地點、時間及行程，不作事先通知。
9.	如天文台發出雷暴警告、紅色或黑色暴雨警告信號、或懸掛三號或以上熱帶氣旋警告信號，當日活動將會取消。如天文台發出雷暴警告、紅色暴雨警告信號、或懸掛三號或以上熱帶氣旋警告信號於活動開始三小時或以前除下，該活動將如期舉行。
10.	如有任何爭議，香港科學館保留最終決定權。
11.	查詢電話：2732 3249/2732 3223 (星期一至五：上午九時至下午一時；下午二時至五時，公眾假期除外)。

Notes of Application
1.	The completed application form should reach the Hong Kong Science Museum, 2 Science Museum Road, Tsim Sha Tsui East, Kowloon by mail or by dropping into the collection box at the museum on or before the closing date of application. Please mark “Field Visit” on the envelop. Late applications will not be processed. Application or reservation by phone or by fax is not accepted. The personal data provided in this form will be used solely for the applied visit, and all data collected will be destroyed after completion of the visit.
2.	You have the right to request access to and correct the personal data as stated in this form in accordance with Sections 18 and 22 and Principle 6 of Schedule 1 to the Personal Data (Privacy) Ordinance. To make such request, please contact the museum at 2732 3249/ 2732 3223 or mail to the Hong Kong Science Museum, 2 Science Museum Road, Tsim Sha Tsui East, Kowloon, Hong Kong.
3.	Each applicant/family should submit one form only for the activity held on the same date. Applicants who submit more than one application form will be disqualified.
4.	Participants will be selected by drawing lots on 6 July 2015. Results will be uploded to the Hong Kong Science Museum websites (http://hk.science.museum) on 8 July 2015. Successful applicants will receive a confirmation letter with instruction of the payment procedures by post.
5.	Successful applicants should follow the payment instruction and settle the payment within the specified period. Copy of document for age verification should also be provided. Otherwise the places would be given to the reserved list.
6.	If there are vacancies after the deadline of application, applications will be accepted on a first come, first served basis.
7.	Fee is non-refundable except in the event of the programme cancellation. It is also non-transferable to other applicants or activities.
8.	The Hong Kong Science Museum have the right to make changes regarding the place, time and itinerary without prior notification.
9.	Field visit programme shall be cancelled on the day when Thunderstorm Warning, Red or Black Rainstorm Warning Signal or Tropical Cyclone Warning Signal No.3 or above is hoisted. If Thunderstorm Warning, Red or Black Rainstorm Warning Signal or Tropical Cyclone Warning Signal No.3 or above is lowered 3 hours or eariler before the visit commences, the visit will be proceeded as scheduled.
10.	In case of dispute, the decision of the Hong Kong Science Museum shall be final.
11.	Enquiries: 2732 3249/ 2732 3223 (Monday to Friday: 9:00am to 1:00pm; 2:00pm to 5:00pm, except public holidays).

活動以粵語進行。解散時間以當日行程安排及交通情況為準。
The activity will be conducted in Cantonese. End time may change subject to the visiting schedule and the traffic conditions of the event day.