Date of receipt: _______________________

0715 Revised H7

TOS I, VI & H and Fixed-Term with Band G, H, I & J

THE UNIVERSITY OF HONG KONG

INSTITUTE OF HUMAN PERFORMANCE

Application for the Use of University Sports Facilities

Please read the notes overleaf and then fill in the details as below:
Personal Details
Name of University Appointee (Mr/Ms): _____________________________________________________________________
(Exactly as it appears on Staff Card)
HKID/Passport No: ___________________________________ Staff number: ______________________________________
Department/Unit: _____________________________________ Position held: _____________________________________
(as given in Letter of Appointment)
Mobile Telephone No: _________________________________ Retirement or Contract End-date: _____________________
Telephone No.: _______________________________________ Email: __________________________________________

Family Membership (if applicable)

Name (same as the HKID Card/Passport)
Spouse
Child
Child
Child
*
**

NA/RE*
NA/RE*
NA/RE*
NA/RE*
NA/RE*

Date of Birth

Age

FAC** No.

For Official Use Only

Delete whichever is inappropriate (NA: New Application; RE: Renewal)

FAC: Facility Access Card

Please put in appropriate boxes:

Section I - Status

New Application

Renewal (if applicable for principal card)

Section II - Total number of Applicants (See overleaf for types and fill in number)

Applicant without Staff Card or FAC

Total number: ____________ x HK$35@ = _______________

Staff cardholder/FAC holder

Total number: _______________________________________

Declaration
I have read the conditions overleaf and confirm my acceptance of them. I hereby apply for the University sports membership and
authorize The University of Hong Kong to deduct the membership fees as agreed by the Committee of Management of Institute of
Human Performance (IHP) and the fee of $35 for the first issuance of EACH FAC from my salary and then to charge the membership fee
annually up to my retirement or contract end-date as stated above, whichever is earlier, unless this arrangement is cancelled by me in
writing to the Director of IHP and by disabling my staff card (and that of my family FAC(s) if applicable) to access the sports facilities.
I also hereby affirm that I / my family members am / are in good physical condition to partake in physical activities and/or exercise.
My/Our participation is purely voluntary and in no way mandated by The University of Hong Kong. I/We also understand that I/we
should monitor my/our own condition throughout exercise/physical activities. I/we should stop the activity or exercising anytime if I/we
have any discomfort or even without any particular reason. In no event shall The University of Hong Kong, its officers, employees, or
agents be held liable for any injury, death, or property loss which I/we may suffer during the activities if caused by either my/our own
negligence, inadequacies in health and fitness or by accident.
Date: ___________________________________________

Signature: _____________________________________
For Official Use

Remark:
______________________________________________________________________________________________________________

Date of receipt: _______________________

0715 Revised H7

TOS I, VI & H and Fixed-Term with Band G, H, I & J

Eligibility
Staff on TOS I, VI & H and Fixed-Term with Band G, H, I & J with their family members are eligible to use University sports
facilities, provided they pay the fees prescribed by the University and comply with IHPs rules and regulations.

Membership Types

Principal member university appointee

Spouse
Child (aged 18 or below)
Senior Child (aged 19-24) each senior child will be charged a separate fee

Application Procedures for New Application and Renewal

For both new application and membership renewal, applicants should return this application form, duly completed and signed, to
Flora Ho Sports Centre of IHP (111-113 Pokfulam Road, Pokfulam, Hong Kong). As the processing of an application normally takes 7
working days of the General Office of IHP, applicants please come to our General Office (address as above) during its opening hours to
collect the membership 7 working days after the application submission. For renewal, applicants should bring along their expired
cards at the time of the sport membership collection. Please note that IHP will not issue any notification to applicant individually
in regard to membership collection and application submitted by fax will not be accepted

Sports Membership Collection

1.

2.

For Applicants without Staff Card or Facility Access Card (FAC)

If applicants do not have a Staff Card or FAC, please come in person to take photo or bring a passport size colour photo(s) taken
within the past 6 months to IHPs General Office during its opening office hours. On the back of the photo(s), please put down
the family members name and his/her HKID/Passport No./relationship as appropriate.
For Applicants with either Staff Card or Facility Access Card (FAC)
If applicants have a Staff Card or FAC, please bring your card to IHP for encoding.

For enquiry concerning membership application, please call 2817 3657 or 2817 4046.

Fees

Membership year starts in every November

Membership for less than 12 months will be charged on monthly pro-rata basis
Scale of charges (subject to review):
(A) Annual Membership Fees
Principal only
$450
Principal & family (excluding Senior Children)
$690
Every Senior Child aged 19-24
$670
(B) Other Fees
The first issuance of each FAC
$35
Replacement fee for each FAC
$100
All fees paid are non-refundable

Payment
The membership fees deducted from salary will be made at the time of application and then every November thereafter. If you wish to
stop the payment deduction, you are required to cancel your membership (please see below).

Cancellation
To cancel the membership, members must write to Director before 15 October and present their Staff Card and all family
FAC(s) (if applicable) for deactivation afterwards. Otherwise, the annual membership fee deduction will continue automatically
until your membership expires.

Admission
Staff Card/FAC(s) must be produced for each entry to any University sports facility and each use / booking of facilities. After their
expiry date, the membership cards will become invalid. On withdrawal of membership or termination of employment, staff card and
all family FAC(s) issued for all users should be presented in person or on behalf of your family members for the deactivation of
membership.
Use of Fitness Room Facilities
Applicants are advised to visit this webpage: http://www.ihp.hku.hk (Sport Sports Facilities Fitness Centres) for details on the
regulations / instructions on using the fitness room facilities.

IHP RESERVES THE RIGHT TO ALTER THE CONDITIONS OF MEMBERSHIP AT ANY TIME.
(Jul 2015) v1