Online Donation

Note: Fields with * are mandatory fields

Support Us

Are you already our donor?
Yes No
Donor ID: *
HKID: * (Last 4 digits ONLY)
Prefix: *	Mr. Mrs. Ms. Miss Dr.
Gender: *	Male Female
Name: *	First Name Last Name
Company Name (if applicable):
Contact Tel No.:
Mobile No.: *
Fax:
E-mail	(Please provide an email address to receive an online acknowledgement of your donation)
Address: *	Home Office




Country:
Donation Information
Donation Type: *	General Donation Monthly Donation Hong Kong Hereditary Breast Cancer Family Registry Partners BOP Donation Scheme TP53 Love Follows Assistance Programme TP53 Give A Gift Donation Donation to Pink Ball
One-time Donation: * Monthly Donation: *	HK $
Receipt Required: *	Yes (For tax deduction purpose) No
Name on Receipt:
Personal Information Collection Statement
The Registry will use your contact information only for the event purpose. All personal data will be kept strictly confidential and handled in accordance with applicable laws. If you agree and wish to receive other communicationmaterials from the Organizer, please tick the box.
Please ‘tick’ one of the boxes: “box” I wish “box” I don’t wish to receive information from Hong Kong Hereditary Breast Cancer Family Registry.