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    Please fill in all * Required blanks

    Name (Chinese) *
    Name (English) *
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    Age *
    18-25
    26-35
    36-40
    over 40
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    Note:

    Your personal data will be kept strictly confidential.

    We shall use your personal data for issuing receipts, fostering communications, raising funds and conducting surveys for the Hong Kong Jayceettes Junior Chamber. We may furnish your data on a strictly confidential basis to Junior Chamber International and its affiliated organizations who provide service to us in relation thereto.