Souvenirs of Queen Mary Hospital
ORDER FORM
To
: Queen Mary Hospital
Room 301, Administration Block
102 Pokfulam Road
Hong Kong
I would like to order the following items
Attention
Telephone
Fax
E-mail
Any personal data provided in this form will only be used for the purpose specified in
this form. Information collected about you will not be disclosed to any other party in a
form that would identify you unless it is permitted or authorized by law. If you wish to
exercise the rights of access and correction with respect to your personal data, please
contact Mr. C. H. Wong, Queen Mary Hospital, Room 301, Administration Block, 102
Pokfulam Road, Hong Kong
: Mr. C. H. Wong
: (852) 2255 4007
: (852) 2817 5496
: wongch@ha.org.hk
:
Souvenirs of Queen Mary Hospital

Please


Local by post,
Name:
Contact Telephone No. :
order/form
Chinese Book on ‘Eating for Health’
Unit
Price
HK$62
「飲食健康新趨勢」
‘Get Well’ Card ( 1 packet of 10 )
Greeting Card ( 1 packet of 10 )
Total
HK$20
HK$20
: HK$
Quantity
Cost
as appropriate :
+ HK$20 postage ( under 1,000 gm )
+ HK$40 postage ( over 1,000 gm )
I enclose a cheque / bank draft ( No.
Date :
Item
) for HK$

Overseas by 2nd class air mail,
payable to Queen Mary Hospital.
Correspondence Address
:
( in block letters )
E-mail Address
:
+
+
HK$60 postage ( under 1,000 gm )
HK$130 postage ( over 1,000 gm )