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
*
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 Account
Cheque
Credit Card
EPS
Cash
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 notice
Cease 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
Preview PDF
Submit
Should be Empty: