HAIR + CONTRIBUTION = WIGS

Full Name : _________________________________________________IC No : ___________________________

Address : ______________________________________________________________________________________

____________________________________________________________ Postcode : _______________________

Mobile No : ______________________________ Email Address: ____________________________________

Extra Contribution (optional) :

Want to help us to raise funds? Be a fund raiser in Simply Giving (www.simplygiving.com/locksofhope).
I would like to to be volunteer in helping the cancer patients !
I would like know more about being a member. Please email me the info.

1 How to Donate ? 2 Cost to Make a Wig - RM800

1) Hair requirement :
I would like to donate to
Length: At least 6 inch/15cm.
Persatuan Kunci Harapan (Locks of Hope) BY:
Condition : Dry, colored/perm/rebonding
please donate after 6 months. Cash : RM
Cheque : No_______________
2) Go to any salon (or we recommend our salon partner) Online transfer : Hong Leong Bank 32200032450
(Please provide slip)
3) Tie a ponytail with a rubber band and cut it.
Debit/Credit Card: www.simplygiving.com/NonProfit/locksofhope
4) Mail this form, contribution and hair to our office:
DONATE RM 1 CAMPAIGN
Locks of Hope Association We thank you for sacrificing your hair for the cancer patients’ need,
unfortunately we need more fund to make more wigs for cancer
29-2, Jalan Temenggung 19/9, Sek 9, patients..
Bandar Mahkota Cheras,
43200 Kajang, Selangor. Malaysia
[For own delivery, please pass to KH Mobile Shop (G floor)]. 3 Delivery Status
* We have only 1 office in the world. For Courier Service, please check with the online delivery status with the
Do not send or give to third party. tracking code provided OR

We will post namelist in the facebook after we have process the parcel,
Donor Signature : please wait patiently for us to reply you.

Please email us full name in capital letter and ic number to receive

e-certificate.
____________________
Date of Donation : Any further question ?
Contact Number : 016-2219005 (Preferbly weekday 10-6pm)
By signing this, I hereby confirm that I willingly agree to donate my hair to the (Please leave a message if no pick up.)
Locks of Hope Association with the intention for the collected hairs to be turned Email Address : locksofhope2014@gmail.com
into wigs for cancer patients undergoing chemotherapy.

Thank you for your donation. 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 2.0