Sabah Kidney Society

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Donation Form

(Print then fill a copy of the form and send the form and the monetary donation to the society)

 Name: _____________________________________

 Address:___________________________________________________________________

              ___________________________________________________________________

Telephone Number : _______________(h) ______________________________(o)
 
To:  The Secretary, 
        Sabah Kidney Society,
        No. 822, Taman Dah Yeh Villa, Jalan Damai, 
        88400,  Kota Kinabalu, Sabah.                                                                                                                          Date: ________________
 
I would like to sponsor a patient for one year and enclose RM15,600.00

I am enclosing a donation of ______________________.

Cheques should be made payable to

SABAH KIDNEY SOCIETY
 
 
 
                                                                                         ...................................................
                                                                                                            Signature  


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