Love Teeth Day

to benefit Oral Health Services for the Needy supported by The Community Chest

Reply Form
PLEASE WRITE IN BLOCK LETTERS. THANK YOU!

YES, we will participate in Love Teeth Day to be held on Wednesday, 4 December 2013.

Our organisation will not be able to participate in Love Teeth Day, but would like to make a donation of
HK$_____________ to support.
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Name of Organisation (Chinese):
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(English):

2. Address:
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3. Head of Organisation/ Dept:

5. Event Co-ordinator:

7. Contact Telephone:

9. Email:
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11. No. of Employees / Members:
1.

4. Position:

6. Position:

8. Facsimile:

10. Donation Pledged:

12. Estimated No. of Participants:

13. No. of Posters Required:

Love Teeth Day Pack

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Quantity Required*:
*
Delivery Address*:

Contact Person:

Contact Telephone:

Email:

Position:

Facsimile:

*
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Love Teeth Day Packs are available on a first-come, first-served basis while stocks last.
Please confirm the quantity on or before Friday, 15 November 2013 to facilitate necessary follow-up.
(In order to minimise administrative costs, the Chest office may contact those organisations with
small number of participants to collect the Love Teeth Day Packs at the Chest office.)

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:

: 2599 6124 / 2599 6151 : 2506 1201

: loveteeth@commchest.org

Please return the completed form to the Chest office by email, fax or mail
Ms Stephanie Tsang / Ms Audrey Au
Address:
Unit 1805, 18/F, Harcourt House
39 Gloucester Road, Wanchai, Hong Kong
Telephone: 2599 6124 / 2599 6151
Fax: 2506 1201
Email:
loveteeth@commchest.org

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/Data collected will be used to keep your
Company / Organisation updated with The Community Chests fund-raising events, marketing & promotional activities, newsletters, volunteer services, surveys to
collect donor opinions, donor acknowledgement and receipt issuance. If your Company / Organisation does not wish to receive information on the Chests future
activities, please tick the box and send this form to the Chest office.