康乐及文化事务署「2017年社区文化大使计划」申请表.doc

康樂及文化事務署「2017年社區文化大使計劃」申請表 “2017 Community Cultural Ambassador Scheme” Application Form Leisure and Cultural Services Department 附註 ：填寫本表格前請先詳細閱讀有關之申請簡介 Note ：Please read the concerned Guide carefully before completing this form. A. 申請者資料 Particulars of Applicant 申請者名稱 (可為藝團或藝術工作者自由組合) Name of Applicant (Arts organization or ensemble of artists) 2. 藝團性質 (只適用於以團體名義申請者。申請藝團必須在最近三年內於本港有實際及高水準的公開演出經驗，香港註冊的藝術團體或機構，並須提供有效的證明文件，例如社團註冊證書、會章、稅務局免稅證明，以證明其屬非牟利機構。) Nature of Arts Group (For applications made in the name of an arts group, the applicant must be a locally registered arts group or organization with actual experience in public performances of a high standard in Hong Kong in the past three years, and is able to produce valid documentary proof in support of its status as a non-profit-making organization, such as a Certificate of Registration issued under the Societies Ordinance, Memorandum and Articles of Association or a tax exemption letter from the Inland Revenue Department.) 3. 申請者居住本港年期(只適用於藝術工作者的自由組合。申請者必須擁有有效的香港身份證。) Years of residence in Hong Kong (For an ensemble of artists only. Applicants must have valid Hong Kong Identity Cards.) 4. 申請者是否已接受其他政府部門或康樂及文化事務署資助推行其他具規模及/或較長期的藝術發展計劃? Has the applicant received grants from other government department(s) or Leisure and Cultural Services Department to carry out large scale and/or long term arts development project(s)? 是Yes ( 否No 如答「是」，請詳加說明。 If Yes, please specify. 5. 申請者地址 Address of Applicant 6. 負責人 / 職銜 聯絡電話： Responsible Person(s) / Position Contact Phone No.: 傳真： Fax No.: 電郵： Email : 7. 計劃聯絡人 / 職銜 聯絡電話： Project Contact Person / Position Contact Phone No.: 傳真： Fax No.: 電郵： Email : 8. 申請者資料 Applicant Details 成立 / 組成日期 Date of establishment : 性質 Nature: ( 非牟利註冊團體 Registered non-profit-making organization ( 其他 Others 成員人數 N