上環文娛中心免費郵寄節目資料服務
Free Mailing Service of Programme Information of Sheung Wan Civic Centre

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

請填妥下列表格寄回香港皇后大道中345號上環市政大廈5樓上環文娛中心或傳真至2851 1075。
(查詢電話：2853 0729)
Please complete the form below and send to Sheung Wan Civic Centre, 5/F, Sheung Wan Municipal Services Building, 345 Queen’s Road Central, Hong Kong or fax to 2851 1075. (Enquiries: 2853 0729)

* 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上環文娛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(港島西)市場推廣及地區活動提出，其地址及傳真號碼載於本表格上。

Notification of Personal Data Collection

	
1.	The information provided by you will be used for mailing of programme information of Sheung Wan Civic Centre 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 (Hong Kong West) Marketing, Programme & District Activities, whose address and fax number are printed on this form.

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