{"id":521,"date":"2022-02-17T17:30:32","date_gmt":"2022-02-17T17:30:32","guid":{"rendered":"http:\/\/www.hkhc.com.hk\/brand\/?page_id=521"},"modified":"2022-07-05T03:58:17","modified_gmt":"2022-07-05T03:58:17","slug":"member-application-form","status":"publish","type":"page","link":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/membership\/individual-member\/member-application-form\/","title":{"rendered":"Member Application Form"},"content":{"rendered":"<p><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-520\"><form id=\"wpforms-form-520\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"520\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/brand\/index.php\/wp-json\/wp\/v2\/pages\/521\" data-token=\"afe488c0e2c0109cda23fdd70c4608dc\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-520-field_21-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"21\"><h3 id=\"wpforms-520-field_21\" name=\"wpforms[fields][21]\">Personal Information <\/h3><div class=\"wpforms-field-description\">*Required<\/div><\/div><div id=\"wpforms-520-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_3\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-520-field_3\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][3]\" placeholder=\"Full Name\" required><\/div><div id=\"wpforms-520-field_4-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_4\">Gender <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-520-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_4_1\" name=\"wpforms[fields][4]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_4_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_4_2\" name=\"wpforms[fields][4]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_4_2\">Female<\/label><\/li><\/ul><\/div><div id=\"wpforms-520-field_22-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_22\">Age<\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-520-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" value=\"18\"\t\tvalue=\"18\"\n\tmin=\"18\"\n\tmax=\"99\"\n\tstep=\"1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Age: {value}\">\n\tAge: <b>18<\/b><\/div>\n<\/div><div id=\"wpforms-520-field_6-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_6\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-520-field_6\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][6][date]\" placeholder=\"(D\/M\/Y)\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-520-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_7\">Occupation<\/label><input type=\"text\" id=\"wpforms-520-field_7\" class=\"wpforms-field-large\" name=\"wpforms[fields][7]\" ><\/div><div id=\"wpforms-520-field_8-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_8\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-520-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required><\/textarea><\/div><div id=\"wpforms-520-field_9-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_9\">Contact No. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-520-field_9\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][9]\" placeholder=\" Phone No.\" required><\/div><div id=\"wpforms-520-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-520-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" required><\/div><div id=\"wpforms-520-field_10-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_10\">Pick Up Branch <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-520-field_10\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][10]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Please select<\/option><option value=\"Jordan Flagship Centre\" >Jordan Flagship Centre<\/option><option value=\"Causeway Bay Branch\" >Causeway Bay Branch<\/option><option value=\"Shatin Branch\" >Shatin Branch<\/option><option value=\"Yuen Long Branch\" >Yuen Long Branch<\/option><\/select><\/div><div id=\"wpforms-520-field_11-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"11\"><h3 id=\"wpforms-520-field_11\" name=\"wpforms[fields][11]\">Other Information<\/h3><\/div><div id=\"wpforms-520-field_12-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_12\">1. Monthly Income:<\/label><ul id=\"wpforms-520-field_12\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_12_1\" name=\"wpforms[fields][12]\" value=\"$5,000 or less\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_12_1\">$5,000 or less<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_12_2\" name=\"wpforms[fields][12]\" value=\"$5,001-$10,000\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_12_2\">$5,001-$10,000<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_12_3\" name=\"wpforms[fields][12]\" value=\"$10,001-$15,000\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_12_3\">$10,001-$15,000<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_12_4\" name=\"wpforms[fields][12]\" value=\"$15,001 or above\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_12_4\">$15,001 or above<\/label><\/li><\/ul><\/div><div id=\"wpforms-520-field_13-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_13\">2. How often do you do health check?<\/label><ul id=\"wpforms-520-field_13\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_13_1\" name=\"wpforms[fields][13]\" value=\"Never\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_13_1\">Never<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_13_2\" name=\"wpforms[fields][13]\" value=\"Once a year\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_13_2\">Once a year<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_13_3\" name=\"wpforms[fields][13]\" value=\"Every two years\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_13_3\">Every two years<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_13_4\" name=\"wpforms[fields][13]\" value=\"Every three years or above\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_13_4\">Every three years or above<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_13_5\" name=\"wpforms[fields][13]\" value=\"Others\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_13_5\">Others<\/label><\/li><\/ul><\/div><div id=\"wpforms-520-field_14-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"14\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-520-field_14\">Others How often do you do health check? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-520-field_14\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][14]\" required><\/div><div id=\"wpforms-520-field_15-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-520-field_15\">How do you know HKHC?<\/label><ul id=\"wpforms-520-field_15\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_15_1\" name=\"wpforms[fields][15]\" value=\"Newspaper\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_15_1\">Newspaper<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_15_2\" name=\"wpforms[fields][15]\" value=\"Website\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_15_2\">Website<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_15_3\" name=\"wpforms[fields][15]\" value=\"Friend\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_15_3\">Friend<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-520-field_15_4\" name=\"wpforms[fields][15]\" value=\"Others \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_15_4\">Others <\/label><\/li><\/ul><\/div><div id=\"wpforms-520-field_16-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"16\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-520-field_16\">Other (How do you know HKHC?) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-520-field_16\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][16]\" required><\/div><div id=\"wpforms-520-field_18-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"18\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-520-field_18\">Data collected will be used to keep you up-dated with Hong Kong Health Check information and membership check up offer. Please tick the box if you do not want to receive information from Hong Kong Health Check.<\/label><ul id=\"wpforms-520-field_18\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-520-field_18_1\" name=\"wpforms[fields][18][]\" value=\"Data collected will be used to keep you up-dated with Hong Kong Health Check information and membership check up offer. Please tick the box if you do not want to receive information from Hong Kong Health Check.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_18_1\">Data collected will be used to keep you up-dated with Hong Kong Health Check information and membership check up offer. Please tick the box if you do not want to receive information from Hong Kong Health Check.<\/label><\/li><\/ul><\/div><div id=\"wpforms-520-field_19-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"19\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-520-field_19\">Read and accept the Terms and Conditions.   <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-520-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-520-field_19_1\" name=\"wpforms[fields][19][]\" value=\"I have read and accept the Terms and Conditions.  \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-520-field_19_1\">I have read and accept the Terms and Conditions.   <span class=\"wpforms-required-label\">*<\/span><\/label><\/li><\/ul><div class=\"wpforms-field-description wpforms-disclaimer-description\"><a href=\"http:\/\/server.4d.com.hk:8080\/raven\/hkhc_brand\/index.php\/terms-of-use\"><u>Disclaimer<\/u><\/a> & <a href=\"http:\/\/server.4d.com.hk:8080\/raven\/hkhc_brand\/index.php\/privacy-policy\" ><u>Privacy Policy<\/u><\/a>\u3002 <\/div><\/div><\/div><div class=\"wpforms-submit-container\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"520\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-520\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img src=\"https:\/\/www.hkhc.com.hk\/brand\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/p>","protected":false},"excerpt":{"rendered":"Please enable JavaScript in your browser to complete this form.Personal Information *RequiredName *Gender *MaleFemaleAge Age: 18 Date of Birth *OccupationAddress *Contact No. *Email *Pick Up Branch *Please selectJordan Flagship CentreCauseway Bay BranchShatin BranchYuen Long BranchOther Information1. Monthly Income:$5,000 or less$5,001-$10,000$10,001-$15,000$15,001 or above2. How often do you do health check?NeverOnce a yearEvery two yearsEvery three years&hellip; <a class=\"more-link\" href=\"https:\/\/www.hkhc.com.hk\/brand\/index.php\/membership\/individual-member\/member-application-form\/\">Continue reading <span class=\"screen-reader-text\">Member Application Form<\/span><\/a>","protected":false},"author":1,"featured_media":203,"parent":201,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"_links":{"self":[{"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/pages\/521"}],"collection":[{"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/comments?post=521"}],"version-history":[{"count":6,"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/pages\/521\/revisions"}],"predecessor-version":[{"id":1377,"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/pages\/521\/revisions\/1377"}],"up":[{"embeddable":true,"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/pages\/201"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/media\/203"}],"wp:attachment":[{"href":"https:\/\/www.hkhc.com.hk\/brand\/index.php\/wp-json\/wp\/v2\/media?parent=521"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}