1. Title Please select (請選擇) Mr Mrs Miss Ms Dr Prof
2. Given name (名字)*
3. Family name(姓氏)*
4. Address (地址)*
5. Address (地址)
6. Address (地址)
7. Country (國家)*
8. Telephone (電話)*
9. Fax (傳真)
10. Email(電郵)*

I would like to support the work of WCRF HK by making an In Memory/In Honour donation (我願捐出下列金額作為紀念捐款，以支持世界癌症研究基金會):

1. HK$1000
2. HK$500
3. HK$300
4. HK$200
5. HK$100
6. Other amount HK$

1. Type of memorial donation 紀念捐款類別(please select the appropriate option 請選擇適用者):
2. In Memory 悼念捐款
3. In Honour 致敬捐款
4. 
   
5. Name of person this gift is in memory/in honour of (此捐款乃為悼念以下人士):
6. Title 稱號： Please select Mr Mrs Miss Ms Dr Prof
7. Given name 名字*
8. Family name 姓氏*
9. Address 地址*
10. Relationship to you 與上列人士的關係
11. Occasion for honour gift 致敬捐款的場合
12. 
    
14. Please send an acknowledgment letter on my behalf to (請代本人把此紀念捐款轉告以下人士) :
15. Title 稱號 Please select Mr Mrs Miss Ms Dr Prof
16. Given name 名字*
17. Family name 姓氏*
18. Relationship to above 與上列人士的關係
19. Address 地址*
20. Address 地址
21. Address 地址
22. Country 國家*
23. Please include the gift amount in the letter 請代通知捐款金額 (tick box 請選擇)

1. Credit card type Please select 請選擇 Visa Mastercard 信用卡類別
2. Credit card Number* 信用卡號碼
3. Card security code * 信用卡檢查碼
4. Expiry Date 到期日* Month 月 01 02 03 04 05 06 07 08 09 10 11 12 Year 年 2010 2011 2012 2013 2014 2015
5. Name on Card * 信用卡上姓名
6. Donations of HK$100 or above are tax deductible with a receipt in Hong Kong 捐款港幣一百元或以上，可獲發收據作扣稅之用。.
7. Would you like a receipt 你需要收據嗎?
8. Yes 需要
9. No 不需要
10. We would like to keep you informed of the work of WCRF HK, including future campaigns. If you would rather not receive further communications, please tick this box 我們希望通知你有關世界癌症研究基金會（香港）的工作及未來的活動。如你不欲再收到本會的訊息，請填寫此欄。