你的支持對我們非常重要。 EmailThis field is for validation purposes and should be left unchanged.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$12,000 可資助1名糖尿病童購買1年的醫療消耗品費用，以改善其家庭生活。My Contribution 我的捐款*One-off donation 一次性捐款 (HK$) $100 $300 $500 $1,000 Other 其他 Other one-off donation Proceed with other one-off donation 进行一次性捐赠 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* Street Address Address Line 2 City State / Province / Region Select Country/City 國家/城市AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Address 電郵* Date of Birth 出生日期 MM slash DD slash YYYY 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*This field is hidden when viewing the formSelect credit card 信用卡 VISA Master Card American Express CAPTCHA “只需每月捐款港幣$100元，你將能減輕糖童的痛苦，使他們的日常生活變得輕鬆一點。”
