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Donor Information  
Prefix* :
First Name* :
Last Name* :
姓氏(中文):
名字(中文):
Gender* :
Date Of Birth: / / (dd/mm/yyyy)
HKID (To avoid donor record duplication only): ( )
Contact No* :
Mobile   Office
Home   Fax
Email* :
Retype to confirm email* :
Please input a valid email address with care, a confirmation email will be sent to you once the donation process is completed.
Donor No: (For de-duplication purpose)
Language Preference * :
Your personal information will be treated as strictly confidential and used solely for handling your donation, issuing receipts, providing donor services, communication, appeal fundraising, feedback collection and inviting you to our health talks and relevant activities, etc. Click here for details of our Personal Data Collection Policy.
Please ✓ one of the boxes:
Address Type* :
Company Name* :
Department* :
Position* :
Address* :
Flat
Floor
Block
Building
Estate
Street No.
Street
Country
Region
District
Post Code
 
Donation Information  
Event Name Stride for a Cure 2017
Donation Amount* :




(Donations over HK$100 are tax deductible)    
Need a receipt* ?
Name on Receipt* :
* Mandatory Fields