HKU Alumni Sports Membership Date of receipt: _____________(0107H24)

THE UNIVERSITY OF HONG KONG (INSTITUTE OF HUMAN PERFORMANCE)

Application for the Use of University Sports Facilities: HKU Alumni & Family (Spouse and Children aged 2-24 only)
Please read the notes overleaf thoroughly and fill in the details as appropriate. Please print or write in English clearly.
Section A: Personal Particulars
A1) Principal (HKU Alumni) Member’s personal particulars

Application Type: New Application / Renewal (Please circle as appropriate):

Name: Mr/Ms: ________________________________________ (Chinese Name, if applicable):

(exactly as it is printed on your HKID Card)

HKID Card No.: ___________________________ HKU Facilities Access Card (FAC) No (if applicable): _________________

HKU Student No: ____________________ Degree(s) obtained: Year of Award: ________________

Mailing Address:

Contact Telephone No: (Mobile) (852) - Email:

A2) Family members’ personal particulars [If you wish to include your family members (spouse and children aged 2-24)
to join the membership, please fill in their details in the space provided below as appropriate.)
Application Type
Name HKID Card / Date of Birth Membership No.
(Please circle as Age For IHP’s use only
(printed on HKID Card) Passport No. (dd/mm/yyyy) (if applicable)
appropriate)
Spouse New / Renewal
Child New / Renewal
Child New / Renewal

Section B: Payment
B1) Fee Amount (Please refer to Section F1 - Scale of payment for details)
No. of applicant(s) Annual Fee (HK$) Sub-Total (HK$) For IHP’s use only

Principal (HKU Alumni) $220 / $610 / $1,980

Spouse & children x $2,200@
First issuance of FAC x $50@
Total:

B2) Payment Methods (Please select one of the following for settling the total required membership fee as in B1 above)

Paid by cheque
Issuing bank: Cheque no: Cheque Amount: HK$

Paid by credit card via direct debit (the credit card bearer has to be the principal member). Only Visa/MasterCard (Credit Card) will be accepted.
I authorize the IHP to charge the required fee amount to my credit card. Details of my credit card are as follows:

Credit card no.: ____________________ - ____________________ - __________________ - ___________________ For IHP’s use only

Issuing Bank: Credit card expiry date (MM/YY): __________ / __________ Total (HK$):

Credit Card Holder’s Signature: Verified by:

Section C: Declaration and Signature

I have read the conditions overleaf and confirm my acceptance all of them, and hereby apply for the IHP sports membership under HKU Alumni Sports Membership Scheme.
Meanwhile, I also hereby affirm that I am / my family members are in good physical condition to partake in physical activities and/or exercise. My / My family
members’ participation is purely voluntary and in no way mandated by The University of Hong Kong. I also understand that I should monitor my / my family members’
own condition throughout exercise/physical activities. I / My family members should stop the activity or exercising anytime if I / they have any discomfort or even
without any particular reason. In no event shall The University of Hong Kong, its officers, employees, or agents be held liable for any injury, death, or property loss
which I / my family members may suffer during the activities if caused by either my / my family members’ own negligence, inadequacies in health and fitness or by
accident.
I / my family members also agree to follow the rules and regulations of the IHP. I assume liability for all damage on the equipment/facilities used by me / my family
members that are caused by myself / themselves due to improper use or non-observance of the IHP’s rules and regulations.
I / my family member shall at all times behave in a decorous manner within the sports facilities, and shall cooperate with the staff of the IHP to ensure that these Regulations and
any subsidiary rules laid down by the Committee of Management are adhered to. I understand the Director and his/her delegated appointee(s) shall have the authority (i) to
request any user to leave the sports facilities, or to cancel their sports membership; or (ii) to suspend temporarily user privileges, for infringement of these Regulations or
subsidiary rules and the Director has the authority to debar any users or persons from using the facilities and/or other user privileges either temporarily or indefinitely.

Date: _________________________________________ Principal (HKU Alumni) member’s signature: _________________________________________________

For IHP’s Use Only

Info. Inspection Principal’s HKID & FAC Spouse’s &/ Child’s HKID & FAC Marriage Cert. Birth Cert. Payment Detail All The aforesaid
Verified by:
Date:

FAC issue/encoded by: __________________________ (Date: _________________________) LMS input by: __________________________________(Date: ________________________)
Remarks:
________________________________________________________________________________________________________________________________________________________
HKU Alumni Sports Membership Date of receipt: _____________(0107H24)
Section D: Eligibility
HKU Alumni and their family members (spouse and children aged 2-24 only) are eligible to apply for IHP sports membership under HKU Alumni Sports Membership subject to the
fulfilment of all of the following:
- HKU alumni as recorded in the HKU’s central student database (Graduation results of fresh graduates will normally be - Compliance with the IHP’s rules and regulation
registered in student database in or after July only.)
- Provide all the required documents as stated in Section G3 for IHP’s information verification - Payment of the required membership fee

Section E: Entitlements
 Members holding valid membership can use the following facilities at the Flora Ho / Stanley Ho Sports Centre during opening hours subject to availability and the relevant
individual booking entitlement. For details, please refer to our website (Sport  Sports Facilities  Booking  Individual Booking).
 Individual booking entitlement: 7-day advance booking or upon availability for using facilities.
- individual booking can be made by phone at 2817 3768 / 2819 4427 or in person with their valid FAC
- to view sports facilities availability before booking, see http://www.ihp.hku.hk (Sport  Sports Facilities  Booking)
- to check facilities closure, see: http://www.ihp.hku.hk (Sport  Sports Facilities  General Information);
- check-in upon arrival is required.
- Car parking is subject to availability & IHP’s policy: http://www.ihp.hku.hk (SportSports FacilitiesBookingCar Parking Policy)
 valid members can invite a maximum of 4 guests to use the sports facilities upon paying the stipulated guest fee for each visit / each 1-hour activity session as appropriate as
per the IHP’s policy: http://www.ihp.hku.hk (Sport  Sports Membership  Guest Policy)
Remark: Child members, aged below 19, should be accompanied by valid IHP adult member(s) and they are not eligible to make any booking and bring guest to use the
facilities.

Section F: Membership Fee and Duration

F1) Scale of Payment (Subject to review and all fees paid are non-refundable):
Annual Membership of the principal (HKU Alumni) is valid for 12 months from the month of Facility Access Card (FAC) issuance / card encoding)
1st year after graduating from 1st Bachelor Degree awarded by HKU $220
2nd year** after graduating from 1st Bachelor Degree awarded by HKU $610
3rd year** after graduating from 1st Bachelor Degree awarded by HKU and thereafter $1,980
Graduates of Post-graduate Programmes $1,980
Family Member (spouse and children aged 2 – 24) per person $2,200
Other Fees
The first issuance of each FAC $50
Replacement fee for each FAC (a FAC replacement form is required, please visit our web: www.ihp.hku.hk for details) $150
** to be determined by the membership activation cut-off date on 30 June.
F2) Duration of Membership
The membership duration for the principal member (HKU Alumni) is on a 12-month basis from the month of issue / encoding or at IHP’s discretion subject to the required fee payment
as above-mentioned. The duration of their family membership will be the same as that of the principal member (please note that the application processing time will be included in the
membership period.). The relevant membership fee of family membership with a duration less than 12 months will be charged on a monthly pro-rata basis, rounded up to the nearest
HK$5. All fees are non-refundable in the case of any membership withdrawal or termination by the IHP.

F3) Payment Methods

The required membership fee can be either paid by cheque, payable to “THE UNIVERSITY OF HONG KONG” (Please put down principal member’s contact phone numbers FAC
number on the back of the cheque) or by direct debit to the credit card provided (The principal member has to be the holder of the credit card concerned).

Section G: Procedures (Application submitted by fax or by email will not be accepted.)

G1) For New Application
The completed application form should be sent to Flora Ho Sports Centre, No. 111-113 Pokfulam Road, Pokfulam, Hong Kong by post or in person. After 7 working days of IHP’s
General Office (Mon – Fri; excluding public and HKU’s holidays), the principal applicant is advised to come in person with all the required documents as stated in Section G3 -
Required Documents as below to Flora Ho Sports Centre (same address as above) during the IHP’s membership service hours (Mon-Fri: 8:30am-12:30pm, 2:00pm-5:45pm,
Sat: 9:00am-12:30pm, excluding public / HKU’s holidays) for his/her/their membership collection. No individual notification regarding membership collection will be given.

G2) For Renewal Application

The principal member is advised to come in person with all the required documents as stated in Section G3 - Required Documents as below to Flora Ho Sports Centre (same
address as above) during the above-mentioned IHP’s membership service hours for his/her/their membership collection. The sports membership can be obtained immediately.

In case the principal member wants a third party to arrange his/her/their family membership collection, the third party should bring an authorization letter together with all the
required document(s) as stated in Section G3 - Required Documents as below and a photo-copy of the principal HKID card accordingly.

For enquiries on membership, please contact us at 2817-3657 or 2817-4046.

G3) Required Documents

Principal (HKU Alumni) Member Family Members (Spouse and children aged 2-24)
For New Application For Renewal Application For New Application For Renewal Application
 Principal member’s original HKID  Principal member’s  Principal member’s original HKID card and original / photocopy of  Principal member’s
card for verification on the spot. original HKID card for each family member’s HKID card for on-spot verification; original HKID card & FAC
 Principal member’s FAC if he/she verification on the spot.  Original / photocopy of Marriage / Birth Certificate (as applicable) as for verification on the spot.
already has one or a recent passport  Principal member’s FAC. a relationship proof of family members for on-spot verification;  Family members’ FAC.
photo for the first card issuance.  Principal member’s and family member’s FAC if they already have
one or a recent passport photo for the first card issuance.
 Cheque payment for membership fee payment. If principal member  Cheque payment for membership fee payment. If principal member opts for credit card payment, please
opts for credit card payment, please present the credit card as stated present the credit card as stated in Section B2 for IHP’s checking.
in Section B2 for IHP’s checking.

Section H: IHP Rules and Regulations

H1) Admission: Member should present their FAC at all times for access to the IHP facilities. The FAC is not transferable.
H2) Rules & Regulations on Using IHP’s Facilities: For the detailed rules and regulations on using facilities, please visit: http://www.ihp.hku.hk (Sport  Sports Facilities 
Rules & Regulation). Please note that unless with the prior approval of the IHP, private teaching / coaching activities are strictly prohibited within the IHP’s facilities, please visit
http://www.ihp.hku.hk (Sport  Sports Facilities Booking  Individual Booking).
H3) Use of Fitness Room Facilities: Applicants are advised to visit: http://www.ihp.hku.hk (Sport  Sports Facilities  Fitness Centres) for details on the regulations /
instructions on using the fitness room facilities
H4) Collection of Personal Date – Statement of Purposes: Applicants please visit: http://www.ihp.hku.hk (Sport  Sports Membership  Collection of Personal Data –
Statement of Purposes) for details.

THE IHP RESERVES THE RIGHT TO ALTER THE TERMS & CONDITIONS OF MEMBERSHIP AT ANY TIME (Jan 2017)