1. Title Please select Mr Mrs Miss Ms Dr Prof
2. Given name*
3. Family name*
4. Address*
5. Address
6. Address
7. Country*
8. Telephone number*
9. Fax
10. Email*

I would like to support the work of WCRF HK by making an In Memory/In Honour donation of:

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

1. Type of memorial donation (please select the appropriate option):
2. In Memory
3. In Honour


4. Name of person this gift is in memory/in honour of:
5. Title Please select Mr Mrs Miss Ms Dr Prof
6. Given name*
7. Family name*
8. Address*
9. Relationship to you
10. Occasion for honour gift


11. Please send an acknowledgment letter on my behalf to:
12. Title Please select Mr Mrs Miss Ms Dr Prof
13. Given name*
14. Family name*
15. Relationship to above
16. Address*
17. Address
18. Address
19. Country*
20. Please include the gift amount in the letter (tick box)

1. Credit card type Please select Visa Mastercard
2. Credit card Number*
3. Card security code*
4. Expiry Date* Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2009 2010 2011 2012 2013 2014
5. Name on Card*
6. Donations of HK$100 or above are tax deductible with a receipt in Hong Kong.
7. Would you like a receipt?
8. Yes
9. No
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