高山劇場免費郵寄節目資料服務
Free Mailing Service of Programme Information of Ko Shan Theatre

請在適當位置加「」。  Please put a “” when appropriate.

□	申請免費郵寄節目資料服務
	Apply for free mailing service of programme information
□	更改個人資料/更新郵遞地址
	Update personal particulars/change postal address
□	取消免費郵寄節目資料服務
	Cancel the mailing service

請填妥下列表格後寄回香港九龍紅磡高山道77號高山劇場或傳真至2781 4783。(查詢電話：2740 9222)
Please complete the form below and send to Ko Shan Theatre, 77 Ko Shan Road, Hung Hom, Kowloon, Hong Kong or fax to 2781 4783. (Enquiries: 2740 9222)

* 先生/太太/女士/小姐 Mr./Mrs./Ms./Miss	Ref. No. :          (For office use only)	
姓名 :
Name																							
	英文English (姓氏在前Surname first)

	中文Chinese
		
地址 :
Address																							

		

地區 :														香港 / 九龍 / 新界	
District		HK / KLN / NT	
		
聯絡電話:																						
Contact Telephone No.	
	*請刪去不適用者  Please delete as appropriate

個人資料(私隱)收集聲明

1.	你所提供的資料將會用作郵寄本中心的節目資料或其他有助市場推廣的用途。
2.	本署可能會將部份資料給予其他政府部門以作上述用途。
3.	除個人資料(私隱)條例所訂明的豁免外，根據同一條例第18及22條及附表1第6項原則，你有權要求查閱及更改本表格內所載的個人資料。
4.	如欲查閱及更改個人資料，請致函給副經理(九龍西)市場推廣及地區活動，其地址為九龍紅磡高山道77號高山劇場。

Notification of Personal Data Collection

	
1.	The information provided by you will be used for mailing of programme information of Ko Shan Theatre and for other related marketing purposes.
2.	The Department may disclose some of your information to other Government departments for the purposes mentioned above.
3.	Subject to exemptions under the Personal Data (Privacy) Ordinance, and in accordance with Section 18 and 22 and Principle 6 of Schedule 1 to the Ordinance, you have a right of access and correction of the personal data provided in this form.
4.	Request for personal data access and correction should be addressed to the Assistant Manager (Kowloon West) Marketing, Programme & District Activities, whose address is at Ko Shan Theatre, 77 Ko Shan Road, Hung Hom, Kowloon.

LCS177