YMCA - Donation Form

PERSONAL PARTICULARS

Note: Fields marked by an * are required.

Company Name *

Title*

Full Name *

Email *

Address *

Postcode *

City *

State *

Country *

Telephone *

Mobile Phone

Fax

Gender

Male

Female

Nationality

Malaysian

Non-Malaysian

NATURE OF DONATION

Cash (RM) *

e.g. 100.00

Reference No: *

In Kind

For whom:*

	Youth Work
	Senior Citizen Work
	Feed the Poor
	Deaf Work (*Tax Exempted)*

PAYMENT OPTION

Name: YMCA KUALA LUMPUR
Maybank Acccount : 514039330191
EON Bank : 0061-10-001246-5
Transaction Description: DONATION

After bank-in, please write your name and Contact No. on the bank slip and fax/email to:

Ng Sok Pan Fax : 603-2274 0559 Email : sokpan@ymcakl.com Tel : 03-22741439 ext 111