Surname :	Mr Ms Mrs	Given Name :
Chinese Name :		Sex :	-- Please select -- Male Female
Date of Birth (D/M/Y):	-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31/ -- 1 2 3 4 5 6 7 8 9 10 11 12/ 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000	Age :	-- Please select -- 17 or below 18 - 25 26 - 35 36 - 45 46 - 55 56 or above
Occupation :	-- Please select -- Executive/Management Professional Education/Academic Clerk Sales/Marketing Arts Student Others	Education :	-- Please select -- Secondary Matriculate College & University Master or up
Language :	-- Please select -- Chinese English
Correspondence address :
Phone : (home)   (Mobile Phone)   (Pager)   (Fax) E-mail :
Interest(s) :   Arts Education Courses - Art diploma Children & Teenagers Courses/Activities Degree Film, Video & New Media Production Leisure Parent-child Exhibition - Contemporary Art Design Traditional Art Film & Video Screening - Animation Classic Independent Performing Arts - Concert Dance Theatre
1.Where did you learn about AC FaN!? Artslink Arts Centre Website Others 2. I would like to receive news and information from Hong Kong Arts Centre in future. Yes No 3. I would like to receive promotional materials from other arts group or organization. Yes No