2010 Youth U.S. Space Camp Application Form
* Compulsory
Last Name(English)
*
First Name(English)
*
Name(Chinese)
*
Gender
*
Male
Female
Date of Birth
*
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
Day
1
2
3
4
5
6
7
8
9
10
11
12
Month
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
Year
Birth Certificate No. / HKID Card No.
*
Passport No.
*
Passport Expiry Date
*
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
Day
1
2
3
4
5
6
7
8
9
10
11
12
Month
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
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.?
*
Yes
No
Emergency Contact 1
Name
*
Home No.
*
Mobile No.
*
Relationship to Applicant
*
Emergency Contact 2
Name
*
Home No.
*
Mobile No.
*
Relationship to Applicant
*