Page 16 - CUHK MEDICAL ALUMNI Newsletter Issue 1 Vol 3 2016

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15

Medical Alumni Contact Update Form

Surname * :
Given Name * :
Year of Graduation * :

Specialty * :
Mobile * :

Email * :
* Mandatory
Providing the following personal information is Optional.

Pager :

Tel. No. (Home) :
Tel. No. (Office) :

Fax No. :
Home Address :

Office Address :

Please “” the appropriate box(es)
If you WISH to receive the CUHK Medical Alumni Newsletter from the Faculty, please state your preference below.
 e-copy ONLY  hard-copy ONLY  NO

 I do not wish to be contacted by CUHK Faculty of Medicine for direct marketing purposes relating to solicitation of
donations and/or promotion of activities of the Faculty.

Personal Information Collection
The Faculty of Medicine treats the data provided by you as strictly confidential. The data is for the Faculty's administration and communication
purposes, e.g. Medical Faculty News, activities, giving initiatives, courses and programmes. It will be synchronized with the University's alumni database.

The Faculty will not disclose any personal information to external bodies unless we have obtained your approval or the Faculty is required to do so by
law. If you do not wish to receive emails from the Faculty in future, please let us know at medical_alum@med.cuhk.edu.hk

Online update:
Medical Alumni Affairs alumni.med.cuhk.edu.hk
Faculty and Planning Office
Faculty of Medicine
The Chinese University of Hong Kong

Room 41026, 2/F, Special Block E Please return this form to Faculty and Planning Office,
Prince of Wales Hospital Faculty of Medicine, CUHK by
Fax: (852) 2649 0208 or
Shatin, N.T.
 Email: medical_alum@med.cuhk.edu.hk