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“serving society with love, care and compassion”

I Want To Sponsor A Child
  1. Name of Individual/ Organisation(*)
    Please input full name
  2. IC No / Company. No(*)
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  3. Occupation (if applicable)
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  4. Address(*)
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  5. Email(*)
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  6. Home Phone
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  7. Office Phone
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  8. H/P
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  9. _________________________________________________________________________________________________________________________________________________

  10. SPONSORSHIP DETAILS :
  11. I / We would like to sponsor(*)
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    How many children do you want to sponsor?
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  14. (*)
    You have to agree with the child sponsorship guidelines to join this program.
  15. _________________________________________________________________________________________________________________________________________________

  16. PAYMENT DETAILS :
    Account Name : Persatuan Kebajikan Agape Melaka
    Account No : 039-201-200251-4
    Bank Name : AmBank Berhad
  17. _________________________________________________________________________________________________________________________________________________

  18. PAYMENT METHOD :
  19. Bank name
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  20. Cheque/transaction no
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  21. Amount
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    in MYR
  22. _________________________________________________________________________________________________________________________________________________
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  24. Please send completed form and bank-in slip via fax/email: +6063341121/agapecaremlk@gmail.com
  25. _________________________________________________________________________________________________________________________________________________
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  27. Please post complete form and cheque to
    AgapeCARE Society
    609, Taman Sri Indah, Kampong 8,
    75200 Melaka, Malaysia.

  28. _________________________________________________________________________________________________________________________________________________
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  30. *ALL DONATIONS TO AGAPECARE ARE TAX-EXEMPT
  31. _________________________________________________________________________________________________________________________________________________
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  33. Enter the numbers to eliminate spam:
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  34.   
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