我想參與11.27 愛心地貧行 Application for Walk for Thalassaemia 11.27

個人報名 Individual
機構 / 團體報名Organization

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機構 / 團體名稱 Organization Name

如屬個人報名, 則不需填寫 Please fill in the following if applicable.

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聯絡人姓名 Contact Person

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稱謂 Title

先生 Mr.
太太 Mrs.
小姐 Miss
女士 Ms.

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聯絡電話 Tel

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電郵 Email

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聯絡地址1 Address 1

証書及收據將於活動後3個月內以郵遞方式發出，請填妥地址欄。Certificate and receipt will be sent by post in 3 months after the event, please provide mailing address.

Must be fewer than 35 characters.

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聯絡地址2 Address 2

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聯絡地址3 Address 3

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每名參加者最低捐款額為港幣100元正 Minimum donations: HK$100/person

總參與人數 No. of Participants

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大會將準備「愛心地貧行2016」証書予參與步行籌款人士，如需索取証書，請填上參加者姓名。 "Walk for Thalassaemia 2016" certificate will be issued to participants with request, please fill in the following if applicable.

參加者姓名1 Name of Participant 1

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參加者姓名2 Name of Participant 2

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參加者姓名3 Name of Participant 3

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參加者姓名4 Name of Participant 4

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參加者姓名5 Name of Participant 5

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所有參加步行籌款人士，籌款額達港幣一百元，可獲贈地中海貧血兒童基金精美T恤一件、吉野家優惠券、屈臣氏蒸餾水等禮品。 Participant who raises HK$100 or above will receive walkathon souvenirs including CTF T-shirt, Yoshinoya coupon, Watsons water etc.

請選擇T恤的尺碼 Please choose T-shirts size participants

XS 件數 Quantity

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S 件數 Quantity

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M 件數 Quantity

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L 件數 Quantity

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XL 件數 Quantity

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贊助人姓名將列印在收據上，於活動日後3個月內以郵寄方式寄出，並由參加者代為分發。 Name of sponsors will be printed on donation receipts. The receipts will be mailed to the participants within 3 months from the event for distribution.

如贊助人需索取收據，請列明 Receipts will be issued to sponsor with request, please fill in the following if applicable.

需要收據 Receipts Required

是 Yes
否 No

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贊助人姓名1 Name of Sponsor 1

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贊助款項1 Donation Amount 1(HK$)

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贊助人姓名2 Name of Sponsor 2

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贊助款項2 Donation Amount 2(HK$)

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贊助人姓名3 Name of Sponsor 3

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贊助款項3 Donation Amount 3(HK$)

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贊助人姓名4 Name of Sponsor 4

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贊助款項4 Donation Amount 4(HK$)

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贊助人姓名5 Name of Sponsor 5

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贊助款項5 Donation Amount 5(HK$)

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贊助人姓名6 Name of Sponsor 6

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贊助款項6 Donation Amount 6(HK$)

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贊助人姓名7 Name of Sponsor 7

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贊助款項7 Donation Amount 7(HK$)

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贊助人姓名8 Name of Sponsor 8

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贊助款項8 Donation Amount 8(HK$)

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贊助人姓名9 Name of Sponsor 9

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贊助款項9 Donation Amount 9(HK$)

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贊助人姓名10 Name of Sponsor 10

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贊助款項10 Donation Amount 10(HK$)

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將轉至贊助/捐款頁面 Proceed to sponsorship payment/donation page