[Open for Application] Dragon's Back Eco Tour x Hiking with Freedom

[Open for Application] Dragon's Back Eco Tour x Hiking with Freedom

日期: 2025年1月25日（星期六）
Date: 25 January 2025 (Saturday)

時間: 上午9時至下午1時 30分
Time: 9:00am – 1:30pm

路線︰龍脊（土地灣至大浪灣）
Route: Dragon's Back (To Tei Wan to Big Wave Bay)

語言: 英語
Language: English

集合地點: 大學站
Gather Point: University Station

解散地點: 筲箕灣站
Dismissal Point: Shau Kei Wan Station

費用 (不設退款):
Programme Fee (non-refundable):

逸夫書院學生: $114
Shaw College Students: $114

逸夫書院職員及校友: $380
Shaw College Staff & Alumni: $380

截止日期: 2025年1月17日 (星期五)
Application Deadline: 17 January 2025 (Friday)

備註:
Remarks:
• 費用已包含專業導師及包車中大至土地灣/大浪灣-筲箕灣地鐵站，不包括午餐。
• Programme fee already covers the cost of tour guide and shuttle bus from CUHK to To Tei Wan and Big Wave Bay to Shau Kei Wan. Lunch is not included.

• 退出或活動當天缺席者需支付全部費用 ($380)。
• Students who withdraw or do not show up on programme day need to pay full cost (HK$380).

• 參加活動的新生將會額外獲得4點PE積分！
• 4 additional PE points will be given to freshmen who participated in the activity!

查詢: 郭小姐 (3943 7361/krizkwok@cuhk.edu.hk)
Enquiries: Ms.Kwok (3943 7361/krizkwok@cuhk.edu.hk)

(1) Personal Particulars
稱謂 Title

稱謂 Title Dr. Miss Ms. Mr. Prof.
英文姓名全寫 Name in English (e.g. CHAN Tai Ming)
中文姓名 Name in Chinese (e.g. 陳太明)
手提號碼 Mobile Phone No.
電鄱地址 Email Address
身份 Identity

身份 Identity 逸夫書院學生 Student of Shaw College 逸夫書院職員 Staff of Shaw College 逸夫書院校友 Alumni of Shaw College
學生編號 Student ID
年級 Year of Study

年級 Year of Study 一年級 Year 1 二年級 Year 2 三年級 Year 3 四年級 Year 4 五年級 Year 5 六年後或以上 Year 6 or above
參加活動的新生將會額外獲得4點PE積分
4 additional PE points will be given to freshmen who participated in the activity

參加活動的新生將會額外獲得4點PE積分 4 additional PE points will be given to freshmen who participated in the activity 不適用N/A PHED 課程編號 PHED course code PHED 課程編號 PHED course code
主修 Major
職員編號 Staff ID No.
單位/部門 Unit/Department
畢業年份 Year of Graduation
年齡 (購買保險之用) Age (for insurance)
緊急聯絡資料 Emergency Contact
聯絡人姓名 (e.g. 陳太明) Name of Contact Person (e.g. CHAN Tai Ming)
聯絡電話 Contact No.
關係 Relationship
付款 Payment (逸夫書院學生Shaw College Students: $114; 逸夫書院職員及校友Shaw College Staff & Alumni: $380):

銀行名稱 Name of Bank: Hang Seng Bank Limited
銀行代碼 Bank Code: 024
戶口名稱 Account Holder Name: The Chinese University of Hong Kong
銀行戶口號碼 Bank Account No.: 293-005005-018 (HKD)

付款方法 Payment Type
1) 轉數快/網上銀行轉賬 FPS / Online Bank Direct Transfer
2) 櫃員機轉賬 ATM Machine Deposit / Trasnfer
3) 現金存款 Cash Deposit at Bank Counter

轉賬付款人銀行戶口持有人名稱 Bank Account Holder Name of Payee

付款 Payment (逸夫書院學生Shaw College Students: $114; 逸夫書院職員及校友Shaw College Staff & Alumni: $380): 銀行名稱 Name of Bank: Hang Seng Bank Limited 銀行代碼 Bank Code: 024 戶口名稱 Account Holder Name: The Chinese University of Hong Kong 銀行戶口號碼 Bank Account No.: 293-005005-018 (HKD) 付款方法 Payment Type 1) 轉數快/網上銀行轉賬 FPS / Online Bank Direct Transfer 2) 櫃員機轉賬 ATM Machine Deposit / Trasnfer 3) 現金存款 Cash Deposit at Bank Counter 轉賬付款人銀行戶口持有人名稱 Bank Account Holder Name of Payee 參加者本人 Same as participant 第三方 Third Party 第三方 Third Party

如銀行轉賬戶口非參加者本人, 請列明轉賬人戶口姓名, 以供核對交易紀錄
If payment via bank transfer from third party bank account, please provide the bank account holder name for checking the payment transcation.
上載付款証明 Upload Proof of Payment

Attach Files
(2) Personal Data Collection Statement:
個人資料（私隱）收集聲明：
參加者所提供的資料只供書院作安排活動之用，如需查閱及更正有關資料，請與書院職員郭小姐聯絡（電話︰3943 7361／電郵︰krizkwok@cuhk.edu.hk。

Personal Data Collection Statement:
The personal data you provided in the form will only be used for the above-mentioned activity. For access to or correction of personal data submitted, please contact Ms. Kwok, Shaw College (Tel: 3943 7361/ E-mail: krizkwok@cuhk.edu.hk).
Declaration:

Declaration: 本人已經詳閱有關活動的報名須知及個人資料(私隱)收集聲明，並且謹此同意遵守。本人聲明報名表內所提供之個人資料，根據本人所知，均正確無訛，亦明白若提供的資料不清楚或不齊全，本人的報名將不獲處理。 I have read and agree with the registration guidelines and the Personal Data Collection Statement. I hereby declare that the information I provided in this application form is complete and true to the best of my knowledge. I understand that my registration will not be considered if I fail to provide all information as requested. 本人明白退出或活動當天缺席者需支付全部費用 ($380)。I understand if I withdraw or do not show up on programme date, I need to pay full cost (HK$380).
Disclaimer The personal data collected will be used by Shaw College and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.