捐款人资料.PDFVIP

Donation Form 捐款表格捐款表格 捐款表格捐款表格 Donor’s Information 捐款人資料 Name (Mr. / Miss / Ms. 先生 / 小姐 / 女士) Mobile 姓名 手提 Organization Fax 機構 傳真 Email 電郵地址 Address 地址 Donation Information 捐款資料 I would like to donate to the following designation(s) (Please tick one or more) 我願意捐獻以下項目: (可選擇多於一項): Adventist Pediatric Heart Fund HK$300 HK$500 HK$1,000 HK$2,000 HK$ __________ 港安幼苗心臟基金 Children’s Hearing Fund HK$300 HK$500 HK$1,000 HK$2,000 HK$ __________ 兒童聽覺基金 Cancer Fund HK$300 HK$500 HK$1,000 HK$2,000 HK$ __________ 癌病基金 Children’s Medical Fund HK$300 HK$500 HK$1,000 HK$2,000 HK$ __________ 兒童醫療基金 Otological Service Fund HK$300 HK$500 HK$1,000 HK$2,000 HK$ __________ 耳科服務基金 Childrens Orthopaedic Fund HK$300 HK$500 HK$1,000 HK$2,000 HK$ __________ 兒童骨科基金 Eye Fund HK$300 HK$500 HK$1,000 HK$2,000 HK$ __________ 護眼基金 Total 總數 HK$ ____________ Donation Method 捐款方法 Monthly donation 每月捐款 One-off donation 一次性捐款 By crossed cheque # 劃線支票號碼# _______________________