Page 16 - CUHK MEDICAL ALUMNI Newsletter Issue 2 Vol 6 2017
P. 16

STAY CONNECTED
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        MEDICAL ALUMNI CONTACT UPDATE FORM


        Please “” the appropriate box(es)
        Surname *                  :

        Given Name *               :

        Chinese Name *             :


        Year of Graduation *       :
        Specialty *                :
        (e.g. internal medicine,

        surgery, paediatrics)
                                    Private Clinic  Hospital

        Please Specify     *    :
        (e.g. Prince of Wales Hospital)

        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    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
      Integrated Event Management,

      Faculty and Planning Office,                              Please return this form to Medical Alumni Affairs,
      Faculty of Medicine,                                    Faculty and Planning Office, Faculty of Medicine, CUHK by
      Room 116, 1/F,                                          Fax:      (852) 3942 0904 or
                                                              Email:
                                                                        medical_alum@med.cuhk.edu.hk
      Choh-Ming Li Basic Medical Sciences Building,
      The Chinese University of Hong Kong,
      Shatin, N.T., Hong Kong
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