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油尖旺同心抗疫新冠疫苗接種日
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* Indicates required question
姓名(Name)
*
Your answer
性別(Gender)
*
男(Male)
女(Female)
生日日期(Birthday)
*
MM
/
DD
/
YYYY
身分證號碼(Hong Kong Identity Card)
*
Your answer
年齡群組(Age of group)
*
3-17
18-59
60歲以上(60 above)
手提電話號碼(Mobile phone number)
*
Your answer
時段(Appointment period)
*
10:00-10:30
10:30-11:00
11:30-12:00
12:30-13:00
14:30-15:00
15:00-15:30
15:30-16:00
16:00-16:30
16:30-17:00
17:00-17:30
17:30-18:00
14:00-14:30
預約接種第幾針(Appointment for)
*
第一針(first dose)
第二針((second dose)
第三針(third dose)
本人同意主辦單位使用本人個人資料供是次疫苗注射活動之用途I consent to the organizer's use of my personal data for the purpose of this vaccination campaign
*
同意(Agree)
提交表格後即可按時出席, 主辦單位不另通知 Once the form is submitted, you will be able to attend on time without notice from the Organizer
*
同意
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