HAIR + CONTRIBUTION = WIGS

Full Name : _________________________________________________IC No : ___________________________

Address : ______________________________________________________________________________________
____________________________________________________________ Postcode : _______________________
Mobile No : ______________________________ Email Address: ____________________________________
I would like to participate as fund raiser in Simply Giving (www.simplygiving.com/locksofhope).
I would like to to be a part of Locks of Hope volunteer in helping the cancer patients !
I would like to to be a part of Locks of Hope member. Please contact for more info.

Sponsor for a Wig

RM800
I would like to donate :
Cheque : Persatuan Kunci Harapan (Locks of Hope)
Chq no_________
Online transfer: Persatuan Kunci Harapan
(Locks of Hope)
Hong Leong Bank 32200032450
(Please provide slip)

Debit/Credit Card:
www.simplygiving.com/NonProfit/locksofhope
RM10 RM 50 RM100 RM200

How to donate :
(1) Hair requirement :
Length: At least 6 inch/15cm long.
Condition : Dry, we accept colored hair.
(2) Go to ANY salon.
(3) Tie a ponytail with a rubber band and cut it.
(4) Mail this form, contribution and hair to:
Locks of Hope Association
50-1, Jalan SL 1/3,
Bandar Sungai Long,
43000 Kajang, Selangor.
Malaysia

I_________________________, I.C. No. _____________________, hereby confirm that I willingly agree to

donate my hair to the Locks of Hope Association with the intention for the collected hairs to be turned into wigs
for cancer patients undergoing chemotheraphy.
Donor Signature :

Contact Detail :
____________________
Date of Donation :

Thank you for your donation.

Contact Number : 016-2219005

Email Address : locksofhope2014hairdonation@gmail.com

You have no rights to change, forge, edit this hair donation form format for
any reason. All are advice to fill up the form for hair donation or contribution. V 1.4

HAIR + CONTRIBUTION = WIGS

: ___________________________________ : ________________________
: ________________________________________________________________________
_____________________________________________ : _____________________
: _______________________ : _________________________________

www.simplygiving.com/locksofhope

RM800
: RM________
: Persatuan Kunci Harapan (Locks of Hope)

Chq no______________
/ATM : Persatuan Kunci Harapan

(1)
6/15cm .

(2)
(3)
(4) /

(Locks of Hope)

Hong Leong Bank 32200032450

()
/:

www.simplygiving.com/NonProfit/locksofhope
RM10

RM 50

RM100

Locks of Hope Association

50-1, Jalan SL 1/3,
Bandar Sungai Long,
43000 Kajang, Selangor
Malaysia

RM200

_________________________, _____________________,
(Locks of Hope Association).
:

____________________
:

Thank you for your donation.

:
: 016-2219005 Ang Ping Hean
: locksofhope2014hairdonation@gmail.com
You have no rights to change, forge, edit this hair donation form format for any reason.
All are advice to fill up the form for hair donation or contribution.
V 1.4