2008 Youth U.S. Space Camp Application Form

* Compulsory

Last Name(English) *
First Name(English) *
Name(Chinese) *
Gender *
Date of Birth * Day Month Year
Birth Certificate No. / HKID Card No. *
Passport No. *
Passport Expiry Date * Day Month Year
Nationality *
School *
Class *
Home Address *
Contact No. (Home) *
Contact No. (Mobile) *
E-mail *
Name of Parent / Guardian *
Relationship to Applicant *
Do you require a visa to U.S.A.? *
Emergency Contact 1
Name *
Home No. *
Mobile No. *
Relationship to Applicant *
Emergency Contact 2
Name *
Home No. *
Mobile No. *
Relationship to Applicant *

Please submit your application form together with a copy of the applicant’s recent report card on or before May 30, 2008. We will send you a confirmation package after the assessment of your application.