New Life Psychiatric Rehabilitation Association

Identity*：

Identity Individual Donation Company Donation

Title*：

Title Mr Ms Not applicable

Name*：

Surname Other Name

or Company Name

Donor ID：

Contact No.*：

Fax No.：

Email：

Address：

(If receipt is needed, please provide us your address.)

Donation Designation*：	Please Specify Donation Designation:
Donation Amount*：	Donation Amount HK$100 HK$300 HK$500 HK$1000 Others HK$
Do you need a receipt?*：	Do you need a receipt? Yes No