Email : info@pisa.org.hk
URL : www.pisa.org.hk
IM: m.me/pisahkg

Professional Information Security Association

Application Form for Student Member

FOR OFFICE USE ONLY

學生會員申請表

Application Ref:
Student Membership

School/College/University Name:
Current year of Study / Field of Study:

MembershipClass:
No:/

Please note: An applicant must be a full-time student ofInformation orComputing
Technology related disciplines.
TI. Personal
Particulars 個人資料

Approved By:
Processed By:(a) Name (Chinese) 中文姓名(b) Current University/College/Institute Vocational Education Student Number(c) Name in full (English) 英文姓名(d) Sex:
Male /Female
性別:男 /女(f) Nationality 國籍(e) Date of Birth (dd/mm/yyyy) 出生日期 (日/月/年)(g) Hong Kong I.D. Card No. 香港身份證號碼(i) Residential Address (Please provide English address where available) 地址(請使用英文)(j) Telephone No.:II.

Home 住所電話(k).Mobile 手提電話(l)E-mail 電郵

Educational Background (in reverse chronological order) 學歷 (請倒序列出)

From 由To 至Mth. / Yr.
月 年Mth. / Yr.
月 年School/College/University Attended(if part-time, please specify)
曾就讀學校名稱(如屬部分時間就讀，請註明)

Qualification Obtained(Certificate, Diploma, Degree, etc. In the case ofdegree, specify classification and field of study)
所獲資格、證書、文憑或學位(請列明所修科目及成績等級)

Date of Award(dd/mm/yyyy)

頒發日期 (日/月/年)

III. Professional Qualifications 專業資格 (please use separate sheet, if necessary/如有需要 請使用額外附頁)
Name of Professional Institution
專業學會Award (Grade or class of membership)
所獲資格 (如會籍類別)How Obtained(e.g. by examination/election)
獲取資格途徑 (如考試/選舉)Date / Expected
Date of Award(dd/mm/yyyy)

頒發日期 (日/月/年)

IV. Practical / Professional Training 職業或專門技能訓練 (please use separate sheet, if necessary/如有需要 請使用額外附頁)
From 由Mth. / Yr.
月 年

V.

To 至
Mth. / Yr.
月 年

Related work experience

From 由Mth. / Yr.
月 年

To 至
Mth. / Yr.
月 年

Title and Description of Training
訓練課程名稱及性質

Name of Organization
受訓機構名稱

Award
所獲資格、文憑或證書

現任職位及過去工作經驗 (please use separate sheet, if necessary/ 如有需要 請使用額外附頁)
Name & Address of Organization
服務機構名稱及地址

Title of Position Held & Nature of Duties
職位及工作性質

VI. Other Information 其他資料 (eg. Extra curricular activities that helps PISA to understand your background demonstrated in respect toInformation technology, securities, etc) (就你的課程,活動等等,有助 PISA 理解你的資訊保安背景)*. An organization for information security professional .
2018-03

VII.

Declaration 聲明2ISC Hong Kong Chapter•

All members will become the members of ISC 2 Hong Kong Chapter.

Personal Data Collection•

I have noted the general points pursuant to the Personal Data (Privacy) Ordinance. The provision collected by means of this form isvoluntary.

•I authorize the Professional Information Security Association or any other office that is directly involved in the administra tion of thisapplication to verify and process my data as required for my application.

•I understand that upon successful application, my data will become a part of my member record in PISA and may be used for all
purposes as prescribed under relevant rules and regulations, so long as I remain member of th is Association.

•I understand that my personal data is collected for the Association’s administration and correspondence purposes, and for kee pingmembers informed of its services. In addition, the Association may use the data collected for its internal sta tistical research andanalysis. Those data might be used to inform me on IT related activities organized by the Association and other organization s.

Declaration and undertaking•

I declare that the information given in support of this application is accur ate and complete in all respect.
misrepresentation will disqualify my application.

•If admitted to the Association, I undertake to be bound by the Constitution of the Association, as amended fro time to time in force
and the traditional code of professional etiquette in all dealings with my associates and PISA from time to time.

•I understand that the Association reserves the right to approve or reject any membership application of any individual.

•If admitted to the Association, I shall subscribe to the Code of Ethics.
by review panel, which may result in revocation of membership.

•I understand that application fee (if applicable) is non-refundable once my student membership status has been approved. In theevent of my resignation from membership, I hereby agree to pay all arrears of subscriptions accrued due to the date of the su rrenderof my Membership Card (if applicable).

Date 日期: _______________________________I understand that any

If I violate any provision of Code, I shall be subject to action

Signature 簽署: ____________________________________________________

Personal Data (Privacy) Notice - Use of Personal Data
People who supply data in their application to the Professional Information Security Association are advised to note the following points, pursuant to the
Personal Data (Privacy) Ordinance:
1. Personal data provided in this application form will, during the entire process, be used solely for this purpose, and in this connection, the data will behandled by the Association’s staff or by any Executive Committee members of the Association who is directly involved in the administration of thisapplication.
2.
3.

Applicants are advised to provide all the information requested in the relevant documents, where applicable, failing which the Association may be unable
to process and consider their applications.
After the applications have been processed and the relevant exercise completed:(a) the information collected from unsuccessful candidates will be destroyed;(b) the application papers of successful candidates will become part of the file which the Association opens for each member.

4.

Under the provisions of the Personal Data (Privacy) Ordinance, applicants have rights to request access to, and to request the correction of, theirpersonal data. Applicants wishing to access or make corrections to their data should submit written requests to the Director of Membership
Administration of the Professional Information Security Association.

VIII.

Application Method 申請辦法1.

Please complete all sections in BLOCK letters. In case any section of the Application Form is not applicable, please put in N/A. The application
MUST be attached with a payment covering the first year annual fee and entrance fee (if applicable). Please refer to the Membership Fee table.
Subscription is due on end June of next year.

2.

Please scan the signed form and the copy of your student card, with the bank deposit slip (if applicable) e-mail to membership@pisa.org.hk.

3.

Applicant is admitted who is a full-time student over 18 years of age, and who is studying a normal full-time academic program as a registeredundergraduate student in Hong Kong.

4.

Processing time for Student Membership application is about 3 weeks.

*. An organization for information security professional .
2021-08