1A - FCC Absent Member Application Form 20210125

1A - FCC Absent Member Application Form 20210125
Date*

日月份年份
日期
Membership Number*
Family Name in capitals*
Given Name(s) in capitals*
Signature*

清除
Current Contact Tel*
Current Email Address*
example@example.com
I shall be leaving Hong Kong on*

日月份年份
日期
For a period of (months/years) *
Please change by status with effect from*

日月份年份
日期
OVERSEAS Address (must be completed)*
Company:
Position:
Address:
Email:
example@example.com
A. I wish to become an Absent Member, and thepayment of HK$2,000 will be settled by:*

Debit my FCC AccountChequeCredit CardEPSCash
B.

I would like to subscribe to TheCorrespondent Magazine at a cost of HK$450 per annum
C.

I request an Early Bill to be collected from Reception on
I request an Early Bill to be collected from Reception on*

月份日年份
日期
D. I have direct debit arrangementscurrently and would like to :

Continue the arrangement untilfurther noticeCease the arrangement after thefinal bill
E.

I have a locker, which I will clear and return the key to, 7 days prior to the effective date of my absent membership. I understand my deposit will be refunded to my account only after the locker is returned in good condition
Should be Empty: