Join Membership

Application for HomeCare Eshop Membership

(A) Member Benefits

(I)	The first 500 successful applicants will enjoy a free membership for the first two years.
(II)	All successful applicants can enjoy one of the following medical tests free of charge once: (a) Blood Oxygen Saturation Test (b) Blood Pressure Monitoring Test (c) Peak Flow Assessment Test (Lung Function Test) (d) Body Fat Analysis
(III)	Members will receive regular news on the newest health care products and information.
(IV)	For every HK$1,000.00 purchase in the E-Shop, customers can receive a Citizen pedometer for free.

(B) Personal Information

Surname	:
Given Name	:
Sex	:	Male Female
Date of Birth	:	// (yy/mm/dd) (Optional)
HKID No.	:	() (Optional)

(C) Contact

Email	:
Mobile	:
Tel No. (Home)	:
Tel No. (Office)	:
Address	:	Room Floor Block
		Building Estate
		Street No./Name
		Hong Kong Kowloon New Territories

(D) Comments

Products that you are interested in (you can choose more than one item):

	Electro Sleep Inducer	Stress Remover
	Negative Ion Generator	Pedometer
	Pedometer with calorie consumption	Heart Rate Monitor
	Blood Circulation Checker	Blood Pressure Meter
	Forearms Upper Body Gym	Multi-Level Back Stretching Device
	Oximeter	Breastfeeding Product
	CPAP Accessories	Nebulizer
	Bedwetting Alar
	Others (please listed):

Other comments:

(E) Declaration

I hereby declare that the above given information is accurate and complete. I understand and accept that my personal data will be made available to the following circumstances:

processing of the application for Homecare E-shop Membership
ordering and delivery services
marketing and promotional activities held by Homecare
Homecare internal statistic and research works

I acknowledge that Homecare reserves the right to interpret the above terms and conditions.

(F) Notes to Applicants

Your membership application will be processed upon receipt of your application. You should receive your membership card by mail within two weeks.