Page 16 - CUHK MEDICAL ALUMNI Newsletter Issue 2 Vol 12 2019
P. 16

medical Alumni Contact Update Form                                                         STAy
                                                                                                 CONNeCTeD





      Please “ü” the appropriate box(es)

      Surname *


      Given Name *

      Chinese Name *


      Year of Graduation *

      Specialty *
      (e.g. internal medicine,
      surgery, paediatrics)

                             ¨ Private Clinic         ¨ Hospital         ¨ Others


      Mobile *

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

      Tel. No. (Office)


      Fax No.

      Correspondence
      Address


      If you WISH to receive the CUHK Medical Alumni Newsletter from the Faculty, please state your preference below.
      ¨ e-copy only            ¨ hard-copy only           ¨ Both                ¨ No

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


           Personal Information Collection
           The personal data collected will be used by CUHK Medicine as well as internal departments for direct marketing and non-direct marketing purposes. We will do this
           through various communication channels such as direct-mail, email, telephone, SMS and messaging tools by using your personal data. The personal data collected
           will be treated in strictest confidentiality. The Faculty will not disclose any personal data provided by you to any external bodies or organisations unless you have been
           previously informed or the Faculty is required to do so by law. The personal data collected will be synchronised with the University’s alumni database. If you do not wish
           to receive emails from the Faculty in the future or should you have further enquiries, please let us know at medical_alum@med.cuhk.edu.hk.



                                                                                ONLINE UPDATE:
        Medical Alumni Affairs
                                                                              alumni.med.cuhk.edu.hk
        Integrated Event Management,
        Faculty and Planning Office,                           Please return this form to Medical Alumni Affairs,
        Faculty of Medicine,                                   Integrated Event Management, Faculty and Planning Office,
        Room 101, 1/F,                                         Faculty of Medicine, CUHK by
        Choh-Ming Li Basic Medical Sciences Building,          Fax: (852) 3942 0904 or
        The Chinese University of Hong Kong,                   Email: medical_alum@med.cuhk.edu.hk
        Shatin, N.T., Hong Kong
                                                                                       C137189
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