Application for Hosting a Mobile Museum Exhibition 流動博物館展覽主辦機構申請表

* Mandatory field 必須填寫

1. Name of School / Organization 學校／機構名稱 *
2. Address of School / Organization 學校／機構地址 *
3. Number of Students / Members 學生／會員人數 *
4. Name of Contact Person 聯絡人姓名 *
5. Title 稱謂 *

5. Title 稱謂 Mr 先生 Ms 女士
6. Position Held by Contact Person 聯絡人職位 *
7. Phone Number 聯絡電話 *
8. E-mail Address 電郵地址 *
9. Selection of ‘Mobile Museum’ Modules (NB. Multiple selections are allowed. The Museum staff will contact the applicant to confirm the availability of the selected modules.) 選擇「流動博物館」展品﹙可選擇多項；博物館職員會致電確認﹚ *

9. Selection of ‘Mobile Museum’ Modules (NB. Multiple selections are allowed. The Museum staff will contact the applicant to confirm the availability of the selected modules.) 選擇「流動博物館」展品﹙可選擇多項；博物館職員會致電確認﹚ (New) Living Greener – an augmented-reality module offering practical things we can do to incorporate sustainability into our daily life. (Space: 2m length x 2m width) 綠活家居──利用擴增實境技術，鼓勵公眾將低碳行動融入日常生活之中（空間：約2米長 x 2米闊） Arctic Moves – an augmented-reality module showing different arctic animals and their characteristics and habits. (Dimension: 1.5m length x 1.5m width) 生動北極──利用擴增實境技術，在雪原上顯示不同的北極動物，介紹牠們的特徵和生活習性（尺寸：約1.5米長 x 1.5米闊） Call to Carbon Action – a multimedia-game module to convey green messages in recycling, resource conservations and low-carbon lifestyle. (Dimension: 1.9m height x 2.1m width x 2.1m depth) 減碳作戰──以不同的電視遊戲從分類回收、珍惜資源和低碳生活三方面展示綠色生活「小貼士」（尺寸：約1.9米高 x 2.1米闊 x 2.1米深） Cast Away on Urban Heat Island – a hologram reproducing in 3D of city model to demonstrate heat islands and their relationship with climate change. (Dimension: 1.9m height x 1.2m width x 0.7m depth) 熱島求生──透過全像投影技術製造立體視覺，深入剖析解熱島和氣候變化的關係（尺寸：約1.9米高 x 1.2米闊 x 0.7米深） Climate Impact – an augmented-reality module exploring the cause of extreme weather incidents and how they may impact the environment and our daily lives. (Dimension: 1.5m length x 1.5m width) 氣候面面觀──利用擴增實境技術，探索氣候變化引致的極端天氣事件，認識其成因以及對環境和人類所帶來的威脅（尺寸：約1.5米長 x 1.5米闊） Climate History Gallery – an augmented-reality module showing the rich history of climate change and how international community became aware of and responded to the threat. (Recommended to reserve at least 10m long hallway for AR interaction) 氣候變化歷史廊──利用擴增實境介紹氣候變化史，認識國際社會如何應對氣候變化所帶來的威脅。（建議預留十米長的空間予參加者瀏覽擴增實境內容） Cut Carbon Farm – an augmented-reality module exploring carbon emissions and environmental impact behind food production. (Dimension: 1.5m length x 1.5m width) 減碳農莊──利用擴增實境技術，在農莊內顯示不同的動植物，介紹糧食生產背後的碳排放及對環境的影響（尺寸：約1.5米長 x 1.5米闊） Green and Clean – a multimedia-game module to reveal the power of nature in tree planting, wind and solar energy. (Dimension: 1.9m height x 2.1m width x 2.1m depth) 低碳高能──以不同的電視遊戲從種植樹木、風力發電和太陽能發電三方面展示大自然力量（尺寸：約1.9米高 x 2.1米闊 x 2.1米深） Ice Secrets – a multi-touch-TV module revealing the secrets of the ice cores. (Dimension: 1.9m height x 0.9m width x 0.5m depth) 冰芯啟示──將動態影像融入實體展品，帶出冰芯的故事（尺寸：約1.9米高 x 0.9米闊 x 0.5米深） Polar Exploration – a hologram reproducing in 3D some of the highlights from the Museum. (Dimension: 1.9m height x 1.2m width x 0.7m depth) 極地探索──透過全像投影技術製造立體視覺，深入剖析多件與極地相關的展品（尺寸：約1.9米高 x 1.2米闊 x 0.7米深） Time Machine – a hologram exploring climate change in time and space with different datasets. (Dimension: 1.9m height x 1.2m width x 0.7m depth) 地球時光機──透過全像投影技術揭示多種與氣候變化相關的數據隨時間而造成的變化（尺寸：約1.9米高 x 1.2米闊 x 0.7米深）
10. Proposed Exhibition Area (such as a hall or a covered playground) and Floor (accessed by lifts) 展品擺放位置（如禮堂或有蓋雨天操場）及樓層（須位於升降機可達樓層） *
11. Purpose of Use 展覽用途 *

11. Purpose of Use 展覽用途 Teaching 教學 Open Day 開放日 Community Activities社區活動 Others 其他（Please specify 請註明）：
12. Proposed Exhibition Period (no more than five days) 預約借用日期（不超過五天）

Option 1 第一選擇：
From 由 12. Proposed Exhibition Period (no more than five days) 預約借用日期（不超過五天）

Option 1 第一選擇：
From 由 * / DD / MM YYYY
To 至 To 至 * / DD / MM YYYY
Option 2 第二選擇：
From 由 Option 2 第二選擇：
From 由 / DD / MM YYYY
To 至 To 至 / DD / MM YYYY
Option 3 第三選擇：
From 由 Option 3 第三選擇：
From 由 / DD / MM YYYY
To 至 To 至 / DD / MM YYYY
Notes on Application 申請須知：

• Subject to application, ‘Mobile Museum’ shall be exhibited at schools or public spaces, at no charge, for a period of five days or less. All applications will be processed on a first-come-first-served basis. Extension of an exhibition period may be considered by the Jockey Club Museum of Climate Change (hereinafter ‘the Museum’), subject to the exhibition schedule and further terms and conditions.
「流動博物館」每次展出的期限不多於五天，申請先到先得。如學校／機構希望延長展出時間，賽馬會氣候變化博物館（下稱博物館）將按照申請情況作個別考慮。

• The Museum will arrange delivery of the ‘Mobile Museum’ modules (hereafter ‘the Exhibits’) to the school / organization. The school / organization shall arrange sufficient staff to provide assistance upon delivery, to ensure that the Exhibits are placed at the proposed area, such as a hall or a covered playground, accessed by lifts. The school / organization shall ensure protection of the Exhibits from strong wind and rain.
博物館將安排運送「流動博物館」展品（下稱展品）到學校／機構。學校／機構需安排職員協助將展品放置在申請時所指定的位置（須位於升降機可達樓層），如禮堂或有蓋雨天操場。學校／機構須確保展品所擺放的位置不受強風及雨水的影響。

• The entrance, pathways and lift doors of the school / organization shall be sufficiently large to allow passage of the Exhibits (the dimensions of each of the exhibits are provided in item 9 'Selection of Exhibition').
學校／機構之入口、通道或升降機門大小須能讓展品安全通過（展品尺寸請參考第9項「選擇展覽」）。

• The school / organization shall ensure adequate power supplies (such as a 3-rectangular-pin 13A plug) for the Exhibits. In case the exhibition area is away from the power supplies, the school / organization shall arrange extension units that comply with relevant safety requirements.
學校／機構需提供足夠電源（例如一個13安培方腳獨立插頭）供展品使用。如電源位置遠離展品位置，學校／機構需安排合乎相關安全規格的電線拖板。

• The school / organization shall be responsible for the safety and order of the students and public during the exhibition period.
學校／機構須負責學生或公眾在參加活動時之安全及秩序。

• The Exhibits are available for loan, at no charge, by schools / organizations. The school / organization hosting the exhibition is required to submit a deposit by means of a crossed cheque of HK$3,000 payable to ‘The Chinese University of Hong Kong’. The deposit cheque will be reimbursed to the school / organization once the Exhibits are returned without any loss or damage (fair wear and tear excepted).
借用展覽組件費用全免。學校／機構須於申請主辦展覽時以劃線支票繳付按金三千港元，抬頭「香港中文大學」。完成展覽後，展品如沒有任何遺失或損壞（正常使用耗損除外），可獲發還按金支票。

• The school / organization shall be responsible for the protection of the Exhibits. In case of loss or damage of the Exhibits (fair wear and tear excepted), the school / organization shall be responsible for the full payment of repair or replacement.
學校／機構須負責保管展品，如有任何遺失或損毁（正常使用耗損除外），學校／機構須負責全部維修或更換費用。

• The Museum possesses the copyright of the Exhibits. The content of the Exhibits shall not be reproduced, duplicated or altered in any format in any way.
展品版權屬賽馬會氣候變化博物館所有，學校／機構不得擅自以任何形式翻印、複製或更改展品內容。

• The exhibition is solely for educational or non-commercial use. The school / organization should not impose any charge on the viewers, or load the exhibits to any third party.
展覽只供教育及非商業用途。學校／機構不得向觀賞者收取任何費用，亦不得擅自將展品外借予第三者。

• The Museum reserves the right of approval for all applications.
博物館保留最終決定權。

• This application form has been translated into Chinese. If there is any inconsistency or ambiguity between the English version and the Chinese version, the English version shall prevail.
此申請表的中文版為英文版之譯本。如中、英文兩個版本有任何抵觸或不相符之處，應以英文版本為準。
Declaration 聲明： *

Declaration 聲明： I hereby certify that I fully understand and agree with the notes above. 本校／機構確認了解並同意以上事項。
Personal Data Disclaimer 個人資料收集聲明

• All personal data collected by the Jockey Club Museum of Climate Change of The Chinese University of Hong Kong (hereafter ‘the Museum’) will be kept confidential and used for this registration only. No personal data will be disclosed to any unauthorized personnel unless they are required to be disclosed under the laws of Hong Kong. 你所提供的資料由香港中文大學賽馬會氣候變化博物館（下稱「本館」）保密處理及作是次登記之用。除非法律許可或有所規定，否則本館不會向未獲授權者披露你的個人資料。
• Under the provisions of the Personal Data (Privacy) Ordinance, you may at any time request access to and correction of your personal data provided in your registration. For enquiries, please contact us on 3943 3972 or by e-mail: mocc@cuhk.edu.hk. 根據《個人資料（私隱）條例》，你有權要求查閱及修正個人資料。如有查詢，歡迎與我們聯絡（電郵地址：mocc@cuhk.edu.hk；電話：3943 3972）。
• The museum may send you information about activities and events. If you do not wish to receive such information, please tick the box below. 本館將透過你的聯絡資料提供活動資訊，若不同意接收，請點選下列拒收資訊欄的空格。
I do NOT wish to receive information about activities and events from the MoCC. 我不同意接收賽馬會氣候變化博物館日後發出的活動資訊。
Disclaimer The personal data collected will be used by the Jockey Club Museum of Climate Change and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

Application for Hosting a Mobile Museum Exhibition 流動博物館展覽主辦機構申請表

Notes on Application 申請須知：

Personal Data Disclaimer 個人資料收集聲明