會籍Membership
我選擇申請 :
I would like to apply for:
1.	□ 	新博物館入場證
		New Museum Pass
	□ 	更新博物館入場證 (舊證號碼:	)
		Renewal of Museum Pass (Previous No.:	)
	□	補領博物館入場證 (舊證號碼:	)
		Replacement Museum Pass (Previous No.:	)
2.	□ 	博物館個人入場證
 		Museum Individual Pass
□	博物館家庭入場證
		Museum Family Pass
□	博物館優惠入場證
		Museum Concessionary Pass:
		□ 	學生 Student 
			(請附全日制學生證及手冊副本)
			(Please enclose a copy of full-time student I.D. Card or Handbook)
		□ 	殘疾人士 People with Disabilities 
			(請附殘疾人士登記證副本)
			(Please enclose a copy of Registration Card for the Disabled)
		□ 	高齡人士 Senior Citizen
			(請附長者咭或其他年齡證明文件副本)
			(Please enclose a copy of Senior Citizen Card or other documents for age verification)
		□ 	海洋公園「智紛全年入場證」持有人 Ocean Park “SmartFun Annual Pass” Holder
			(請附海洋公園「智紛全年入場證」副本)
			(Please enclose a copy of Ocean Park “SmartFun Annual Pass”)
			(會員證號碼Membership No.	 )
3. 		□ 全年 Full Year         □ 半年Half Year  (不適用於家庭入場證Not Applicable to Family Pass)
個人資料 Personal Particulars 
英文姓名*: (請用大楷填寫)  Name in English*: (In BLOCK Letters)    
																																								
姓氏 Last Name                                   名字 First Name
中文姓名*:  Name in Chinese*:
	
性別  :  □ 男     □ 女            出生日期* 	 日	   月      年
Sex:	        Male      Female        Date of Birth*: ______D______M______Y
通訊地址:  Correspondence Address :

□ 香港 Hong Kong   □ 九龍 Kowloon  □ 新界 New Territories  □ 海外 Overseas
聯絡電話*:					電郵地址:
Contact Telephone No.*:_______________________ 	E-Mail Address:______________________________ □
			如您希望收到續證提示的電郵通知服務, 請提供電郵地址並於空格內加上「」號。
If you wish to receive an email notification for the renewal of museum pass, please provide your e-mail address and tick the box to apply this service.

家庭會員資料 Family Members’ Particulars
英文姓名* :  (請用大楷填寫) Name in English* :  (In BLOCK Letters) 	
																																									
姓氏 Last Name                                      名字 First Name	
中文姓名* :
Name in Chinese*: ___________________________
性別  :  □ 男     □ 女            出生日期* 	 日	    月     年
Sex:        Male      Female        Date of Birth*: ______D______M______Y

聯絡電話* Contact Telephone No.*: _______________________
與申請人關係(須為親屬):
Relationship with the Applicant (with kinship): _____________________________________________
	
英文姓名* :  (請用大楷填寫) Name in English* :  (In BLOCK Letters) 	
																																									
姓氏 Last Name                                      名字 First Name	
中文姓名* :
Name in Chinese*: ___________________________
性別  :  □ 男     □ 女            出生日期* 	 日	    月     年
Sex:        Male      Female        Date of Birth*: ______D______M______Y

聯絡電話* Contact Telephone No.*: _______________________
與申請人關係(須為親屬):
Relationship with the Applicant (with kinship): _____________________________________________
	
英文姓名* :  (請用大楷填寫) Name in English* :  (In BLOCK Letters) 	
																																									
姓氏 Last Name                                      名字 First Name	
中文姓名* :
Name in Chinese*: ___________________________
性別  :  □ 男     □ 女            出生日期* 	 日	    月     年
Sex:        Male      Female        Date of Birth*: ______D______M______Y

聯絡電話* Contact Telephone No.*: _______________________
與申請人關係(須為親屬):
Relationship with the Applicant (with kinship): _____________________________________________
	
*必須填寫 Compulsory Field 

博物館季刊 Museum Quarterly Newsletter

如您希望收到下列博物館的季刊，請於下列空格內加上「」號。我們會在你的博物館入場證有效期間把季刊如期寄上。
If you wish to receive the quarterly newsletters published by the following museum(s), please tick the appropriate box(es) below and you will receive the newsletters during the validity period of the Museum Pass.

□ 香港科學館
   Hong Kong Science Museum	□ 香港太空館
   Hong Kong Space Museum	
□ 香港藝術館
   Hong Kong Museum of Art	□ 香港文化博物館
   Hong Kong Heritage Museum	
□ 香港歷史博物館/香港海防博物館/孫中山紀念館
   Hong Kong Museum of History/Hong Kong Museum of 
   Coastal Defence/ Dr Sun Yat-sen Museum		

個人資料(私隱)條例通知
申請人所提供的資料，只供申請康樂及文化事務署博物館入場證、郵寄博物館季刊及宣傳單張之用。申請人如附上身分證副本作年齡証明文件，副本將會在核實後銷毀。根據個人資料(私隱)條例，你有權要求查閱及更正所提供的個人資料。如對填報個人資料有任何查詢，請與有關博物館經理聯絡。	

Personal Data (Privacy) Ordinance Notification 
The personal data provided by means of this form will be used solely for the application of the Leisure and Cultural Services Department Museum Pass, mailing of the newsletters and other publicity materials. Photocopy of the ID Card, if  provided for age verification, will be destroyed after use. The applicant has the right to request access to and correct his/ her own personal data in accordance with the Personal Data (Privacy) Ordinance. For enquiries, please contact the Manager of the respective museums.	

請將填妥表格連同所需的證明文件副本及劃線支票(抬頭「香港特別行政區政府」)，寄回或親身交回背頁任何一間博物館。如於遞交申請表格後一個月仍未收到博物館入場證，請致電有關博物館查詢。
	
Please send this duly completed application form together with the required supporting document(s) and a crossed cheque (payable to “HKSAR Government”) to one of the museums printed overleaf by post or in person. If you do not receive the Museum Pass in a month after you have handed in the application, please contact the respective museums.

				____________________			____________________________________
				(日期Date)				(申請人簽署Signature of Applicant)

此欄不用填寫 For Office Use Only
  Museum Pass Details 

□ Individual 	□ Family	□ SmartFun	
□ Student 	□ People with Disabilities 	□ Senior Citizen	
□ Replacement 	□ Complimentary		
□ Full Year	□ Half Year		
	
	Barcode No.:____________________   Date Received : _____D_____M_____Y
	Cross Reference to Museum Pass No.: ____________________________________
	Validity Period: ___________________________to__________________________
	
	Payment Details
M.R. No.:		
□ Cash : HK$		
□ Cheque : HK$		Date:		
Bank:		
Cheque No.:		

Checked & Authorized By:		Date Issued:	

	
			
(M / AM)		D  M  Y	

Data Input
Quick Registered by:		Date:		
Record Completed by:		Date:		

博物館入場證持有人可獲以下優惠
1.		於博物館入場證有效期內可無限次參觀下列博物館的展覽廳(部份專題展覽除外) : 香港科學館、香港太空館(何鴻燊天象廳節目除外)、香港藝術館、香港歷史博物館、香港海防博物館、香港文化博物館及孫中山紀念館。
2. 	於設在博物館內的禮品店/書店以現金購買特選貨品可獲九折優惠。
3.		參與博物館主辦的活動(如科學館的電腦課程及以上博物館的教育推廣活動)可獲九折優惠。參加活動費用倘為優惠價錢，則不能同時享有此優惠。
4.		申請海洋公園「智紛全年入場證」可獲九折優惠，並享有海洋公園「智紛全年入場證」的其他優惠。

Benefits of Being a Museum Pass Holder
1.	Unlimited admission during the valid period of the Museum Pass to the exhibition halls of the following museums (excluding some special exhibitions): Hong Kong Science Museum, Hong Kong Space Museum (excluding the Stanley HO Space Theatre programmes), Hong Kong Museum of Art, Hong Kong Museum of History, Hong Kong Museum of Coastal Defence, Hong Kong Heritage Museum and Dr Sun Yat-sen Museum.
	
2.	10% discount on cash purchase of selected items at museum gift shops/ bookshops.	
3.	10% discount on participation in museum extension activities solely organized by the Museums (e.g. computer courses organized by the Science Museum and educational programmes organized by the above museums). This discount is not applicable to fees which are already rebated under other concessionary schemes.
	
4.	10% discount on Ocean Park “SmartFun Annual Pass” and enjoy related benefits.	

有效日期
博物館全年入場證 : 由發證日期起十二個月內
博物館半年入場證 : 由發證日期起六個月內

Period of Validity 
Full Year Museum Pass: Within 12 months from the date of issue.
Half Year Museum Pass: Within 6 months from the date of issue.

使用須知
1.		每證只限持證人使用。
2.		申請人需出示博物館入場證方可進入博物館參觀。
3.		博物館入場證不得轉讓。持證人於入場時或須出示身分證明文件。
4.		博物館入場證一經發出，概不退換或兌現。
5.		如遺失博物館入場證，請即時向任何一間博物館報失。補領新證每張費用如下:
			博物館個人入場證 : 十元
			博物館家庭/優惠入場證 : 五元
6.		博物館入場證持有人請於入場證有效期屆滿前於任何一間博物館辦理更新手續。
7.		博物館入場證持有人須遵守博物館規例及各間博物館的場館規則。

Conditions of Use
1.		Each Museum Pass admits the pass holder only.
2.		Museum Pass Holders must present the Museum Pass for admission to the Museum Exhibition Hall.
3.		The Museum Pass is non-transferable. Museum Pass holder may be required to produce identity proof upon admission.
4.		The Museum Pass is neither returnable nor refundable once issued.

5.		Loss of the Museum Pass should be reported to any one of the museums immediately. A replacement Museum Pass will be issued with the following fee:
			Museum Individual Pass	: $10
			Museum Family/Concessionary Pass: $5
6.		Museum Pass holders may renew their Passes at any one of the museums upon expiry.
7.		Museum Pass holders should comply with the Museums Regulation and house rules of the museums.

博物館入場證費用*
	全年	半年	
個人	$100	$50	
家庭
(最多四人，須為親屬)	$200	－	
優惠
(全日制學生、殘疾人士及六十歲或以上高齡人士)	$50	$25	
* 海洋公園「智紛全年入場證」持有人可獲九折優惠。

Museum Pass Fee*
	Full Year	Half Year	
Individual 	$100	$50	
Family 
(for a maximum of 4 persons with kinship)	$200	－	
Concessionary
(full-time students, people with disabilities and senior citizens aged 60 or above) 	$50	$25	
* 10% discount for Ocean Park “SmartFun Annual Pass” holders.

查詢		電話/網址	
1.  	香港藝術館
香港九龍尖沙咀梳士巴利道10號		2721 0116
http://hk.art.museum	
2.	香港歷史博物館
香港九龍尖沙咀漆咸道南100號		2724 9097
http://hk.history.museum	
3.	香港太空館
香港九龍尖沙咀梳士巴利道10號		2721 0226
http://hk.space.museum	
4.	香港科學館
香港九龍尖沙咀東部科學館道2號		2732 3232
http://hk.science.museum	
5.	香港海防博物館
香港筲箕灣東喜道175號		2569 1500
http://hk.coastaldefence.museum	
6.	香港文化博物館
香港新界沙田文林路1號		2180 8188
http://hk.heritage.museum	
7. 	孫中山紀念館
香港中環衛城道7號		2367 6373
http://hk.drsunyatsen.museum	

Enquiries 		Telephone No./ Website	
1.  	Hong Kong Museum of Art
10 Salisbury Road, TST, Kowloon, Hong Kong 		2721 0116
http://hk.art.museum	
2.	Hong Kong Museum of History
100 Chatham Road South, TST, Kowloon, Hong Kong 		2724 9097
http://hk.history.museum	
3.	Hong Kong Space Museum
10 Salisbury Road, TST, Kowloon, Hong Kong		2721 0226
http://hk.space.museum	
4.	Hong Kong Science Museum
2 Science Museum Road, TST East, Kowloon, Hong Kong 		2732 3232
http://hk.science.museum	
5.	Hong Kong Museum of Coastal Defence 
175 Tung Hei Road, Shau Kei Wan, Hong Kong		2569 1500
http://hk.coastaldefence.museum	
6.	Hong Kong Heritage Museum
1 Man Lam Road, Sha Tin, New Territories, Hong Kong 		2180 8188
http://hk.heritage.museum	
7.	Dr Sun Yat-sen Museum 
7 Castle Road, Central, Hong Kong		2367 6373
http://hk.drsunyatsen.museum	

LCS 25b