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會員資料更新表 Member Information Update Form
無論有否變更，均請各位會員重新填上個人資料，以便更新會員紀錄。謝謝!
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* Indicates required question
會員類別 Category of Membership
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基本會員 Full Member
附屬會員 Associate Member
Required
姓名 Name (中文/Chinese)
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Your answer
姓名 Name (英文/English)
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Your answer
性別 Gender
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男 Male
女 Female
Required
出生日期 Date of Birth (日DD /月MM /年YY) 如: 24/01/91
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Your answer
現/曾任職業 Occupation
Your answer
教育程度 Education
Your answer
骨髓移植日期 Date of BMT (日DD /月MM /年YY) 如: 24/01/91
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Your answer
骨髓移植 地區/醫院 City/Hospital of BMT
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Your answer
會員編號 Member No. :
Your answer
骨髓移植類別 Category of BMT
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親屬 Relative
非親屬 Non-Relative
自體 Autologous
病類 Diagnosis
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急性骨髓性白血病 Acute Myeloid Leukemia (AML )
慢性骨髓性白血病 Chronic Myeloid Leukemia (CML )
急性淋巴性白血病 Acute Lymphoblastic Leukemia (ALL)
慢性淋巴性白血病 Chronic Lymphoblastic Leukemia (CLL)
淋巴瘤 Lymphoma - 何杰金氏 (HL)
淋巴瘤 Lymphoma - 非何杰金氏 (NHL)
多發性骨髓瘤 Multiple Myeloma
骨髓增生異常綜合症 Myelodysplastic Syndromes (MDS )
其他(請註明) Other (please specify )
Required
居住 / 聯絡地址 Residential / Contact Address (中文 / Chinese)
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Your answer
居住 / 聯絡地址 Residential / Contact Address (英文 / English)
Your answer
聯絡電話 Tel
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Your answer
電子郵件 Email
Your answer
請選擇希望以何種方式收取會訊?
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WhatsApp 電子版
郵寄
閣下是否有意參與本會義工工作 Would you like to be volunteer of the Association
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是 Yes
否 No
本人願意成為癌協服務使用者並由負責職員與我聯絡 l agree to accept services provided by Cancerlink and to be contacted by their staff.
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是 Yes
否 No
本人同意並授權本會使用閣下於此更新表上提供的所有資料，以作本會或癌協開展各項會務活動、福利 服務、文娛康樂等用途。我們會遵守香港特別行政區法例第486章《個人資料(私隱)條例》，嚴格遵從有 關的保安及保密標準，並將資料妥善保存。
*
是 Yes
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