附錄四「香港教師中心教育團體會員」申請表，以新視窗打開

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54 附錄四致:九龍九龍塘沙福道 19 號教育局九龍塘教育服務中心西座一樓 W106 室香港教師中心諮詢管理委員會秘書處

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香港教師中心「香港教師中心教育團體會員 J 申請表本團體認同香港教師中心的宗旨(詳見章程第二條) ，欲參與香港教師中心的工作，現申請加入成為香港教師中心教育團體會員，本團體及聯絡人的資料如下: 團體註冊名稱 _(中文) (英文) 通訊地址 (中文) (英文) 電話: _傳具: 網址: 電部地址: 註冊類別豁免註冊/公司/社團/職工會* 註冊號碼: 註卅日期: 團體成立的宗旨請附上團體的註冊文件及章程副本各一份，並填寫附件內的教育團體簡介。現有會員 _{人/校* ，其中} _{人/校*乃檢定教師/註冊學校* ，或豁免} 總數註冊者。請填寫附件內的會員資料，提供 10 位會員姓名及教師註冊證號碼或任教學校名稱。教育團體類別選擇(請於下列各項中選擇一項) 本團體申請加入口師資培訓機構口辦學團體及學校議會口校長團體口教師工會口學科團體口教育評議及研究團體口其他教育團體 *請刪去不適用者

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聯絡人(團體必須填寫執委會其中三名委員的有關資料) 有關收集個人資料聲明:這份表格內填報的個人資料，只供香港教師中心諮詢管理委員會作審批申請、存中當及通訊之用。填報表格內的個人資料，純屬自願性質。如未能提供足夠資料，可能會影響申請的審批。 (一) 主席/會長姓名(中文) (英文) (姓名電碼) 職位主席/會長* 職業辦公地址住址 (二) 姓名在團體內的職位職業辦公地址住址 (三) 姓名電話: 電話: (中文) (姓名電碼) 電話: 電話: (中文) (姓名電碼) 在團體內的職位職業辦公地址電話: 住址電話: 教師註冊證號碼(如適用) 傳真: 傳真: 電郵: (英文) 教師三主冊證號碼(如適用傳具: 傳具: 電郵: (英文) 教師註冊證號碼(如適用) 傳真: 傳真: 電郵: 若本會加入為香港教師中心團體會員，本會欲將以下資料顯示於香港教師中心網頁內。聯系各人: ( 中文 )

|材 J

( 英文 ) 地址: ( 中文 ) ( 英文 ) 電話: |傳具:

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|網址 J 本人聲明此表格所載的資料屬實。若資料與事實不符，香港教師中心有權取消本會的團體會員資格。蓋章

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(請劑去不適用者 ) 簽署主席/會長*姓名團體名稱日期 55

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會員資料

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團體註冊名稱 (中文) (英文) 會員姓名教師註冊證號碼/任教學校名稱 2 3 4 5 6 7 8 9 10

教育團體簡介

請以不超過 200 字介紹教育團體的資料，內容可色括團體的宗旨、活動及網址等，以使教師中心作推廣用。

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To: Secretariat of Advisory Management Committee (AMC), / ~

Hong Kong Teachers'Cen帥" (

W106, 11F, EDB Kowloon Tong Education Services Centre, 19 晶晶lkRoad, Kowloon To略 Kowloon.\ )

HONG KONG TEACHERS' CENTRE

Application for

“

Membership of Education Organisations of the Hong Kong Teachers' Centre" Our organisation agrees to the aims and objectJives ofthe Hong Kong Teachers' Centre (as per Constitution Article 2) and would like to participate in the work of the HKTC. We would like to apply for admission as a member of Education Organisation of the Hong Kong Teachers'

Cen甘e.Details of our organisation and contact persons are as follows: .

The Organisation Registered name Correspondence address Registration type P 冒且訕。 sn m-m ••• 且 4•••• 。 "au --tc3 1 例 UM---且 en v 且 qa 泡。叫 Mr

---o

釗‘他 R 仙 (in Chinese) (in English) (in Chinese) (in English) Tel. No. Website FaxNo. E-mail

exempted from registration / limited company / society / trade union*

Registration No. 一一一一一一一一一一一_ Registration Date

Please append to this form a copy each of the registration document and the constitution of the organisation. Please also provide an introduction to the organisation in the Appendix.

一一一一一 individuals/ schools*, of whom / which a total of 一一_are registered teachers / schools*, or are teachers / schools who / which are exempted from reglstratlOn.

Please complete the 益stof 10 members with their names and teacher registration numbers I school names in the Appendix.

Choice ofEducation Organisations Category (Please indicate only one choice) Total membership

at present

Our organisation would like to be c1assified as

口 TeacherEducation Institutions

口 Organisationsof School Heads

口 Subject-relatedOrganisations

口 OtherEducational Organisations

口 SchoolGroups & Sponsoring Bodies

口 Teachers'Unions

口 EducationalCommentary & Research Organisations

* Please delete whichever is not appropriate!applicable

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Contact Persons

fPlease flll In the Informatlon of three exec'utlve members of the Executlve Commlttee) Personal Information Collection Statement: The personal data provided in the application form will only be used by the Advisory

Management Committee of the Hong Kong Teache 悶，Centre for vett:ing, record and correspondence purposes. The provision of personal

data in this application form is on voluntary basis. The lack of adequate information may affect the vetting of the application

(A)

Name (in Chinese) (in English) (code of Chinese name, if any)

President / Chairperson* Position

Occupation Office address

Teacher regis仕ationnumber (if applicable)

Home address

(B) Name

Te1. No. Fax No.

(in Chinese)

(code of Chinese name, if any) Position in the organisation

E-mail

(in English)

Occupation Offìce address

Home address

(C)

Name

Te1. No. Fax No.

(in Chinese)

(code of Chinese name, if any) Position in the organisation

E-mail

(in English)

Occupation Offìce address

Te1. No. Fax No. Home address

Te1. No. Fax No. E-mail

If admitted as member, our organisation wishes to disclose the following information on the HKTC website.

Contact : (Chi)

|叫

(Eng)

Address : (Chi) (Eng)

Tel : IFax: I

|恥bsite:

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1 declare 的at， to 的ebest of my knO\再rledge，the information provided in this application form is 釘ueand accurate. If otherwise, the Hong Kong 1切chers'Centrereserves the right to cancel the membership ofmy organisation.

Chop

Signature Name ofPresident I Chairperson* Name of Organisation Date

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Narne of organisation

Membershin Information

(Chi) (Eng)

Appendix

Narne ofMernber Teac:her Registration No. / Narne of School

2 3 4 5 6 7 8 9 10

Introduction to O

n:

mnisation

For prornotion purpose, please providl::: a brief introduction to the education

organisation in not rnore than 200 words. The brief could inc1ude the objectives,

activities & website, etc, of the organisation.

附錄四 「香港教師中心教育團體會員」申請表 ，以新視窗打開

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