Online Donation Form - Youth Diabetes Action

Phone

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Select Donation Type 捐款類別

First

One-off donation
一次性捐款

Every dollar can make a difference to the lives of children with diabetes and their family. No child held back because of diabetes.
請捐款支持我們，讓糖尿病不再是孩子的障礙。

Third

Monthly donation
月捐

Help YDA to continue our work in providing the vital services for children with type 1 diabetes and their family.
協助我們為一型糖尿病患童及其家人提供服務

Second

Sponsor a child
資助兒童計劃

Your donation of HK$12,000 will help one family in need pay for essential medical equipment and healthcare items for a year.
港幣$12,000 可資助1名糖尿病童購買1年的醫療消耗品費用，以改善其家庭生活。

My Contribution 我的捐款*

One-off donation
一次性捐款 (HK$)

Other one-off donation

One-off donation – Sponsor a child*

HK$12,000 sponsor a child for a year.
港幣12,000資助1名糖尿病童購買1年的醫療消耗品費用

Monthly Donation 月捐*

HK$100/month support a child with Type 1 diabetes with 2 weeks’ worth of insulin pen needles.
每月港幣100，可資助1名糖尿病兒童購買2星期的胰島素注射針頭費用
HK$200/month support a child with Type 1 diabetes with a month’s worth of blood test lancets.
每月港幣200，可資助1名糖尿病兒童購買１個月的採血針費用
HK$300/month support a child with Type 1 diabetes with a month’s worth of blood test lancets and insulin pen needles.
每月港幣300，可資助1名糖尿病兒童購買１個月的採血針及針頭費用
HK$600/month support a child with Type 1 diabetes with a month’s worth of blood glucose test strips.
每月港幣600，可資助1名糖尿病兒童購買１個月的血糖試紙費用
Other 其他

Other monthly donation*

Personal Particulars 捐款者資料

Donor’s Information 捐款者資料

* Mandatory Fields 必須填寫

Reason for donation 捐款項目*

General Donation 一般捐款
YDA children diabetes handbook 兒童糖尿手冊 (HK$100)
Million Step Challenge 百萬健步挑戰

Which version of "YDA children diabetes handbook" do you want to have? 你想取得哪個版本的《兒童糖尿手冊》？*

Chinese version 中文版
English version 英文版
I don’t need a copy. 我不需要。

Name of Challenger 挑戰者姓名

First Last

Title 稱謂

Mr 先生
Ms 女士
Mrs 太太
Miss 小姐

Name/Company Name 姓名/公司*

Contact No. 聯絡電話*

Address*

Email Address 電郵*

Date of Birth 出生日期

Preferred Language 溝通語言

English
中文

Receipt Preference 收據*

E-receipt
電子收據
Paper receipt
實體收據
No receipt
不用收據

Name on Receipt 收據抬頭*

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Select credit card 信用卡

VISA
Master Card
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Your support means a lot to us.

Select Donation Type 捐款類別

Personal Particulars 捐款者資料

Donor’s Information 捐款者資料