「南行覓跡：M+藏品中的東南亞」導賞服務預約表格 'In Search of Southeast Asia through the M+ Collections' Tour Request Form Survey

學校／團體導賞服務時段：
2018年6月22日至2018年9月30日
星期三至星期五，上午11時至下午6時
星期六和星期日，上午11時至下午1時30分

School / Group Tour Availability:
22 June to 30 September 2018
Wednesday to Friday, 11:00am to 6:00pm
Saturday and Sunday, 11:00am to 1:30pm

預約手續: 請填妥表格，並於所選的參觀日期最少14天前提交。M+ 會於10個工作天內以電郵回覆申請人，以確定參觀日期及有關安排。如有任何疑問，請電郵至 learn@mplus.org.hk 或致電 (852) 2200 0041 與我們聯絡。

Booking Procedure: Please submit the completed request form at least 14 days in advance of the preferred visiting date. M+ will contact you via email to confirm the tour date and arrangement within 10 working days. For enquiries, please contact us at learn@mplus.org.hk or (852) 2200 0041.

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* 1. 團體性質 Group type:

小學
Primary school

中學
Secondary school

專上學院 / 大學
Post-secondary institution / university

特殊學校
Special school

復康機構
Rehabilitation organisation

其他註冊學校 / 慈善團體 / 非牟利機構
Other registered school / charity / non-profit organisation

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* 2. 參觀日期及時間 Date & time of visit:
首選 First choice

日期 Date:

Date

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* 3. 時間 Time:

11:00am – 12:00pm

12:30pm – 1:30pm

2:00pm – 3:00pm (星期六、日除外 Except Saturdays & Sundays)

3:30pm – 4:30pm (星期六、日除外 Except Saturdays & Sundays)

5:00pm – 6:00pm (星期六、日除外 Except Saturdays & Sundays)

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* 4. 次選 Second choice

日期 Date:

Date

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* 5. 時間 Time:

11:00am – 12:00pm

12:30pm – 1:30pm

2:00pm – 3:00pm (星期六、日除外 Except Saturdays & Sundays)

3:30pm – 4:30pm (星期六、日除外 Except Saturdays & Sundays)

5:00pm – 6:00pm (星期六、日除外 Except Saturdays & Sundays)

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* 6. 導賞語言選擇 Tour language:

粵語 Cantonese

英語 English

普通話 Mandarin

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* 7. 你需要通達服務嗎？Do you require access services?

不需要 I do not need access service

需要即時口述影像（以口語描述視覺資訊） Live Audio Description (translation of visual information to spoken language)

需要手語傳譯（即時轉換口語和手語） Sign Language Interpretation (between spoken language and sign language)

M+ 將根據上述註明盡量安排所需之服務，惟是否能提供，仍須視實際情況而定。
Arrangement depends on the availability of the service. M+ will try to accommodate the above preference.

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* 8. 請列明其他特定需要 Please inform us of any other specific requests:

展廳內部分通道狹窄，如參加者中有輪椅使用者，建議團體先向本館職員查詢通達路線。不便之處，敬請見諒。
Some areas of the galleries are narrow. If there are wheelchair users in your group, we encourage you to consult our staff for advice on accessible routes. We are sorry for any inconvenience caused.

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* 9. 參觀總人數 Total no. of visitors^:

^名額（包括隨行領隊／陪同者／教職員數目）Capacity (including accompanying leaders / support persons / teachers):

一般學校或團體導賞團：15至30人

15–30 participants for are needed to reserve a general school or group tour

通逹導賞團：10至25人

10–25 participants are needed to reserve for a tour with access services

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* 10. 隨行領隊 / 陪同者 / 教職員數目 No. of accompanying leaders / support persons / teachers^:

^建議每10至25人1位領隊。Recommend one leader for every 10–25 visitors

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* 11. 是否需要申請交通費津貼？ ( 申請詳情及資格請參閱「交通費津貼申請表」)
Do you need to apply for a transportation subsidy? (For details and eligibility, please refer to the Transportation Subsidy Application Form.)

需要 Yes

不需要 No

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* 12. 學校 / 機構名稱 Name of school / organisation:

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* 13. 地址 Address:

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* 14. 年齡 Age group:

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* 15. 年級 (學校適用) Grade / form (for schools):

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* 16. 科目 (學校適用) Subject (for schools):

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* 17. 請填寫參觀目的或有關參加者的補充資料 Please indicate the objectives of your visit, or any other additional information about the participants:

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* 18. 活動負責人 Person-in-charge:

活動負責人姓名 (中文):

Name of the person-in-charge (English):

職位 Post:

電郵 Email:

手提電話 Mobile no.:

辦公室電話 Office tel.:

傳真號碼 Fax no.:

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* 19. 隨行領隊（如非活動負責人）
The Accompanying staff (if different from the person-in-charge):

姓名 Name:

手提電話 Mobile no.:

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* 20. 聲明 Disclaimer:

茲證明上述由本人所屬學校 / 機構授權提交之資料均正確無誤，並無遺漏。
I hereby certify that all the above information provided on behalf of my school / organisation is correct and complete.

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* 21. 導賞服務預約須知和私隱政策 Notes on Tour Booking and Privacy Policy:

本人已閱讀並接受導賞服務預約須知和西九文化區管理局的私隱政策。
I have read and accept the Notes on Tour Booking and the West Kowloon Cultural District Authority Privacy Policy.

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* 22. 資訊 News:

本人同意透過電郵 / 郵寄方式收取西九文化區管理局 / M+的資訊。
I agree to receive news about West Kowloon Cultural District Authority / M+ through email / post.

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* 1. 團體性質 Group type:

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* 2. 參觀日期及時間 Date & time of visit: 首選 First choice

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* 3. 時間 Time:

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* 4. 次選 Second choice

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* 5. 時間 Time:

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* 6. 導賞語言選擇 Tour language:

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* 7. 你需要通達服務嗎？Do you require access services?

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* 8. 請列明其他特定需要 Please inform us of any other specific requests:

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* 9. 參觀總人數 Total no. of visitors^:

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* 10. 隨行領隊 / 陪同者 / 教職員數目 No. of accompanying leaders / support persons / teachers^:

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* 11. 是否需要申請交通費津貼？ ( 申請詳情及資格請參閱「交通費津貼申請表」) Do you need to apply for a transportation subsidy? (For details and eligibility, please refer to the Transportation Subsidy Application Form.)

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* 12. 學校 / 機構名稱 Name of school / organisation:

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* 13. 地址 Address:

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* 14. 年齡 Age group:

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* 15. 年級 (學校適用) Grade / form (for schools):

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* 16. 科目 (學校適用) Subject (for schools):

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* 17. 請填寫參觀目的或有關參加者的補充資料 Please indicate the objectives of your visit, or any other additional information about the participants:

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* 18. 活動負責人 Person-in-charge:

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* 19. 隨行領隊（如非活動負責人）The Accompanying staff (if different from the person-in-charge):

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* 20. 聲明 Disclaimer:

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* 21. 導賞服務預約須知和私隱政策 Notes on Tour Booking and Privacy Policy:

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* 22. 資訊 News:

* 2. 參觀日期及時間 Date & time of visit:
首選 First choice

* 11. 是否需要申請交通費津貼？ ( 申請詳情及資格請參閱「交通費津貼申請表」)
Do you need to apply for a transportation subsidy? (For details and eligibility, please refer to the Transportation Subsidy Application Form.)

* 19. 隨行領隊（如非活動負責人）
The Accompanying staff (if different from the person-in-charge):