Newsletter - Hong Kong Hereditary Breast Cancer Family Registry

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HK Hereditary
Breast Cancer Family Registry
香港遺傳性乳癌家族資料庫
Newsletter
Issue No. 2
M AY 2 0 1 1
Established in December 2007, HK Hereditary Breast Cancer Family
Registry (“THE REGISTRY”) is a charity established to serve the Asian
population of women (and men) and their families who are at high risk of
being diagnosed with breast, ovarian and prostate cancer due to a family
history of the disease. Working together with our counterpart, Hong Kong
Hereditary and High Risk Breast Cancer Programme (HRBCP), information
and continuous care for the underprivileged and high-risk groups is being
provided so that intervention can take place at an early stage, saving lives
through early detection.
Message from Chairman, Dr. Ava Kwong
Welcome to the second issue of THE REGISTRY newsletter. This issue will give
you an overview of THE REGISTRY’s progress so far. Up to February 2011,
we have a total of 731 individuals who underwent the BRCA1/2 genetic test
and genetic counselling. Among those, 165 individuals were found to carry
the BRCA mutation (72 were the index patients and 93 family members of
these index patients were mutation carriers). Following the implementation
of a new technique (HRM) this year, the processing of the genetic testing will
be greatly improved. At THE REGISTRY we are thankful for the opportunity
to give high-risk breast cancer patients hope by providing them with an
early detection programme based on new technologies and local research.
In the review of year 2010, THE REGISTRY had organized a number of
fundraising activities despite limited resources and manpower. Among
the many held activities, THE REGISTRY launched its first public education
campaign, BReast Concern Action (BRCA) in May 2010 to increase the
understanding of hereditary breast cancer. The results were uplifting and
more details about this are to follow.
Without government funding, we rely on generous donations from companies
and individuals to ensure our work in fighting against breast cancer due
to hereditary cause. Thank you for your dedication to achieve our motto:
When cancer runs in the family, We care, We help and We change. Your
support enabled us to make a positive difference to breast cancer patients
and their families in desperate need of a helping hand.
c/o HK Sanatorium & Hospital
8/Floor, Li Shu Fan Block,
2 Village Road, Hong Kong SAR
Tel: 2835-7028
Email : enquiries@asiabreastregistry.com
www.asiabreastregistry.com
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 1
to reach women between ages of 30 - 50 years old on the
risk factors for breast cancer. The design of the exhibition
booth resembled a friendly homey environment, with
educational panels of vital breast cancer information and
characteristics of the high-risk hereditary breast cancer
groups. Being in a comfortably surroundings, the general
public were able to relax and discuss their concerns with
our breast care nurses and genetic counsellors in a non
clinical setting. Nearly 100 women learnt the techniques
of breast self-examination (BSE) from the breast care
nurses in their own privacy. Over 500 visitors came
to the booth for information leaflets and brochures,
115 individuals participated in our health surveys and
68 cases were referred to our genetic counsellors for
follow up having found to be at risk of hereditary breast
cancer.
Upcoming Events
June / July 2011 - BReast Concern Action (BRCA) will be reaching out to corporate organizations on hereditary
breast cancer during the summertime. We have several talks already on the agenda; however, we are keen to
give additional talks. It could be at your office/ clubs during lunch hour or after office hour. We want to bring you
the knowledge to take control of your health. The topic ranges from the most recent statistics of the disease, to a
comprehensive look at Breast Health, Diet and Cancer, Relationships and Communications, Symptoms and Side
Effects after treatment.
18 September 2011 - HK Hereditary Breast Cancer Family Registry will be organizing its first charity sport event,
Race With Pink Heels, a fun-filled fundraising and educational event to raise funds and awareness about hereditary
breast cancer. BE in her shoes, and Race to help BRCA patients! Please come and join us by registering to one or
more categories of the Race. Individual, couples, family and corporate organizations are all welcome! This is an
event not to be missed.
29 October 2011 - Our 4th annual gala, Pink Ball will be held at Grand Hyatt Hong Kong. Come and dance for a
good cause! This is a popular event of the year and our tables go quickly! So hurry and call us to reserve a table at
2835-7823. FIRST COME FIRST SERVE.
Our heartfelt thanks go to our generous Campaign
Supporters: Estēe Lauder Companies, Hong Kong
Sanatorium & Hospital, La Mod Salon, Shung Hing
Group Panasonic, and TOUS. Also, we want to convey
our special thanks to Mr. Enrico Kwong and Ms. Vivian
Yeung for helping to make the Campaign possible. And
of course, we have to pay tribute to our volunteers and
media partners as the campaign would not have such a
great response without their contribution. More details are
available at www.asiabreastregistry.com.
October Breast Cancer Awareness Month - For our online charity products sales, remember to check for updates on
our website: www.asiabreastregistry.com. We have tons of surprises in store for you.
For more details of the above events, please visit www.asiabreastregistry.com | Enquiries: 2835-7028
BReast Concern Action (BRCA) 2010
Educating the Public about Cancer and Genetics
BReast Concern Action (BRCA), sponsored by Kerry
Group Kuok Foundation, aimed to raise the awareness
of hereditary breast cancer. The campaign was kicked off
at Times Square on 6 May 2010 with the presence of
THE REGISTRY TLC Star Ms. Joey Yung, TLC Ambassadors
Ms. Jessica Huen and Mr. Enrico Kwong; as well as
Ms. Vincy Chan and Ms. Jolie Chan. Our TLC Star Ms.
Joey Yung and our Chairman Dr. Ava Kwong were on
stage and unveiled the music video of BRCA theme song,
Hopes of Women, produced by Mr. Enrico Kwong and
Mr. Joseph Ip. Also, we were grateful to Dr. Tony Mok, a
renowned oncologist at Prince of Wales Hospital and our
TLC Ambassador, Ms. Jessica Huen who helped spread
life-saving messages about hereditary breast cancer
during the event day.
One of its main activities was a three-day, roving exhibition
held in shopping malls at Times Square, Metro City II and
Olympic City throughout May/ June, respectively. Breast
Care Nurses, Nursing Students, Genetic Counsellors
and staff volunteered throughout the campaign period to
provide immediate advices for women and their families
on risk of hereditary breast and ovarian cancers. With a
combined effort of healthcare professionals, we were able
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 2
Patient Services
When Cancer Runs In The Family,
We Care, We Help And We Change
When someone is looking for breast cancer advice,
particularly when there is a family history of breast or other
cancers, THE REGISTRY is where people can turn to.
Sharing from Elaine Tsui in genetic counselling:
The purpose of genetic testing is to deliberate the risk of a
genetic condition not only for the individuals who attend the
genetics clinic but also their family members. This genetic
information facilitates treatment, management and prevention
of disease, as well as informed choices in reproductive
decisions. Genetic counselling is a communication process
dealing with the potential dilemma associated with the
genetic condition amongst the family. Thus, the family
communication pattern of genetic information is one of the
most important areas to be addressed during the counselling
session.
A patient of ours, L, diagnosed with breast cancer in her mid-twenties, and
later underwent breast surgeries and a series chemotherapy and radiotherapy
treatments. We met L in a genetic consultation almost a decade after her first
diagnosis whilst her mother was also diagnosed with breast cancer in her late fifties. Prior to the genetic testing for
hereditary breast and ovarian cancer, L and her mother received genetic counselling given by the genetic specialist.
The counselling session involves a family risk assessment followed by thorough explanation on the clinical implication
of genetic testing on individuals and families, clinical management options, and the limitations of genetic testing.
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 3
The results of the genetic testing were found to be positive for L whereas L’s mother was found negative. It implied
that the BRCA gene mutation was originated from the paternal side. Under normal circumstances, L would be advised
to encourage her paternal family members to undergo the genetic testing. However, the case got complicated as
L’s parents were divorced for more than 20 years. After further consideration and discussion, L decided to talk to
her father about her genetic condition as she hoped that her half siblings can be informed and take necessary
surveillance and prophylactic procedures.
The communication pattern about genetic risk amongst the family members is influenced by individual factors such as
the perceived responsibility to pass on the relevant information to affected family members, and relationship factors,
for example, the closeness between the family members. We have to be mindful about these factors in genetic
counselling, ensuring patients and their families are given sufficient information and psychological support in order
to make an informed choice appropriate to their personal and family objectives.
the disease,” she explains. Further, there are ways to improve breast cancer survival rates. One is to perform breast
cancer research which can give us indications on how to improve treatment. The second way is the prevention of
breast cancer caused by BRCA 1 or BRCA 2 genetic mutations.
In addition to Breast Concern Action (BRCA) last year, THE REGISTRY organized a series of health talks on hereditary
breast cancer for the employees at corporate level, such as Bossini Hong Kong Head Office, Emperor Watch &
Jewellery and PricewaterhouseCoopers Hong Kong Office. A range of topics were discussed broadly at these
gatherings. From genetic breast cancer diagnosis, cancer treatment to breast reconstruction, the audiences took
home with more knowledge to take control of their health. The awareness of psychological impact on BRCA mutation
carriers, both patients and family members, and the importance of family support were stressed profoundly during
the talks.
Breast Concern Action Corner
Research
Your contribution at work ... together we can make a difference …
The past year was a time of continued growth and exciting collaborations. THE REGISTRY had established overseas
collaborations with a number of universities/research centres in genetic studies in countries such as United Kingdom,
USA, Canada, Iceland, Korea, Japan and Macau. Through collaborative work we have collected a bank of blood,
DNA and cancer tissue samples from a group of high-risk Chinese patients and families, some of them are BRCA 1
or BRCA 2 mutation carriers. These are considered valuable assets and are contributing to hereditary breast cancer
research worldwide for the understanding of genetic environmental interaction against the cause of disease. With
further research analysis and data sharing with other countries, we hoped to seek, refine and understand better the
hereditary breast cancer risk factors in order to help and improve the clinical management in Hong Kong and other
nearby countries. One of the major advances we have made is to discover a Founder mutation in the BRCA 2 gene
in Chinese patients in Hong Kong. Since then our screening strategies have changed so that it can be more cost
effective thereby making testing more available to more high-risk individuals.
Public Education
In each issue we will interview someone who is involved
either directly or indirectly in our work, to talk about
their views and values towards the HK Hereditary Breast
Cancer Family Registry.
Kan Pik Yu, Nurse of Comprehensive Oncology Centre:
I have been working in the Comprehensive Oncology
Centre of Hong Kong Sanatorium & Hospital since
2003. As time goes by, I have observed the increasing
number of cancer patients in the family - brothers, sisters,
father and son, mother and daughter, or couples were
diagnosed with cancer at a young age. This shows that
the urban lifestyles as well as genetic hereditary factors
have a significant implication on the risk of diagnosis of cancer. Throughout my professional years in the Oncology
Centre taking care of cancer patients, I have encountered their anxiety and pressure which resulted from the illness
and treatments. When one of the family member is living with cancer, the entire family would suffer, let alone two
or more. It is not difficult to imagine how much exhaustion the illness brought upon the family, and that is the reason
why prevention and early detection of cancer should be concluded as part of the cancer treatment.
With the recent development of genetic studies on breast and ovarian cancers, genetic mutations in family members
have been detected early for timely preventive measures so as to reduce cancer risk. I felt honored to be involved
with and participated as a volunteer at the Breast Concern Action campaign organized by HK Hereditary Breast
Cancer Family Registry in May 2010. I was truly impressed with the fact that although Hong Kong people knew
little about cancer genetic research, they were eager to find out if they are being mapped into the high-risk group
and the willingness to take preventive measures. Genetic research is not commonly known and most patients and
their families were not familiar with the subject in Hong Kong. In order to increase the awareness of hereditary
breast cancer genetic research, more resources should be dedicated to public education starting from children at
young age and be included in as primary health care education for the public sector in Hong Kong. Cancer is still
a largely incurable disease even with today’s scientific advancement. As compared to the cost for cancer treatments,
it is definitely more worthwhile to invest in prevention and early treatment. I wish more donations could come from
the general public in support of the development of genetic research, genetic screening and counselling for the
underprivileged, breast cancer patients and their families. This will help to alleviate the burden of the family as
a whole.
Community education and outreach are a core component of THE REGISTRY’s mission and have been Dr. Kwong’s
beliefs. “As a specialist in hereditary breast cancer, it‘s my obligation to make sure the general public is aware of
the risk factors in developing cancer such as breast and ovarian cancers related to the presence of family history of
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 4
I am closely linked to cancer. My sister is a breast cancer patient at a young age and I deeply feel the far-reaching
effects of cancers on both the individual and the entire family. So I want to apply what I learnt at the Comprehensive
Oncology Centre to serve and benefit more cancer patients and their families, helping them to pursue a meaningful
life beyond cancer.
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 5
Fundraising
Recent Highlights
On Friday, 29 October 2010, more than 350 friends and supporters of the HK Hereditary Breast Cancer Family
Registry gathered at the Grand Hyatt Hong Kong for the 3rd Pink Ball- Rhythm of Life benefiting the HRBCP. Garnering
over HK$4 million in donations, the event set a new Pink Ball record. All proceeds would go towards breast cancer
research and the HRBCP, which supports high-risk breast cancer patients and their families for the genetic counselling
and screening for BRCA mutations.
Sponsored by Estēe Lauder Companies and Joseph Lau Luen Hung Charitable Trust, Pink Ball provided guests
with a unique evening of dancing, socializing and delicious foods. Spectacular charity and professional dance
performances were carried out with grace and spirit. We were truly grateful to the support of our major sponsors,
ruby sponsors, platinum sponsors, gold sponsors, table sponsors, corporate sponsors, advertisements and raffle
prizes sponsors. We hope Pink Ball will continue to grow with your support and participation in future years.
Nov 2010
Designed by Belford Jewellery, Caring with Sparkle - Ribbon
Collection was showcased at The Landmark Mandarin Oriental Hotel
on 12 November. 3% of the sale proceeds of the Ribbon Collection
in between November and December were donated to the HRBCP,
for supporting the underprivileged breast cancer patients and their
families to undergo genetic testing and counselling. In addition, Belford
Jewellery additionally contributed a total sum of HK$80,000 toward
The Registry’s hereditary breast cancer awareness programmes.
Nov 2010
A total sum of HK$190,000 was generated from The Charity
Scarf Action for the benefit of HK Hereditary Breast Cancer
Family Registry. Estēe Lauder Re-Nutriv announced the launch
of The Re-Nutriv Charity Scarf Action at the unveiling ceremony
in Times Square Atrium on 3 November. During November to
December 2010, there were a total of 1,000 pieces of limited
edition scarf designed by Ms. Coco Lee, Ms. Elizabeth Lee,
Ms. Flora Zeta and Dr. Ava Kwong, packaged in a tailor-made
gift set and sold at Estēe Lauder counters/stores in support of
the hereditary breast cancer awareness programmes.
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 6
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 7
Recent Highlights
Oct 2010
With support in its third year of “October International Breast
Cancer Awareness Month”, TOUS launched the sale of TOUS x THE
REGISTRY 2010 Ice Pink Pendant during the month of October and
November this year. TOUS donated a total sum of HK$80,000 to
THE REGISTRY for clinical and supportive care services, community
awareness programmes and research for better understanding of
the disease.
Recent Highlights
Sept 2010
The Peninsula Hotel was illuminated in pink lights
to celebrate the October Breast Cancer Awareness
Month, an effort that began three years ago at
Times Square landmark initiated by The Estēe
Lauder Companies. During the press event on
28 September, Mr. Kenneth Wong, Managing
Director of The Estēe Lauder Companies, and our
Chairman, Dr. Ava Kwong, illuminated The Peninsula
Hotel to kick-off The Estēe Lauder Companies Breast
Cancer Awareness Campaign - reminded women to Be Breast Aware
and helping to save lives. This certainly made an impression to those
who were present on the evening and passers by during the month of
October.
During the month of October, eight of its beauty brands jointly
organized a charity sale of limited pink products in support of
THE REGISTRY. A donation of HK$500,000 was contributed to the
research study of family members of the breast cancer BRCA carriers
whose aged 40 year old or under, to undergo genetic testing and
counselling.
Oct 2010
Sponsored by Emperor Watch and Jewellery (HK) Ltd.,
THE REGISTRY hosted its second fundraising musical
show in 2010 – GREASE. A limited number of premium
seats tickets were sold to our patrons, families and
friends to watch the best-beloved musical performance
whilst supporting the HRBCP. Proceeds of HK$ 162,000
were generated from the musical show.
Aug 2010
Mr. Enrico Kwong has kindly donated HK$15,000 in support
of the HRBCP, proceeds from the sale of “Enrico Kwong – My
Story Your Stories 2010 Album + Charity Photo Exhibition
Sale”.
May 2010
With the support of Pricewaterhouse Coopers and Sanofi
Aventis Pharmaceuticals, THE REGISTRY hosted its first
fundraising musical show – Chicago on 23 May. A total of
150 premium seats tickets were sold to our patrons, families
and friends to see the musical performances whilst supporting
the HRBCP. A proceed of HK$155,000 was generated from
the fundraising event.
Oct 2010
THE REGISTRY was benefited from the Charity Fashion
Show at the Estēe Lauder - Re-Nutriv Gala Dinner held at
Four Seasons Hotel Ballroom on 21 October. A total of
six pieces of couture dresses designed by Ms. Flora Zeta were
silent auctioned in order to raise funds for THE REGISTRY.
A proceed of HK$114,730 was donated to THE REGISTRY
in support of the breast cancer awareness programmes.
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 8
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 9
Recent Highlights
May 2010
To mark the 20th anniversary of Piaget Possession
jewellery collection, Piaget has greatly supported
THE REGISTRY through the launch of Possession
collection exhibition from 13 May to 16 May
at Pacific Place and Times Square, respectively.
To demonstrate the mutual support between
THE REGISTRY and women afflicted by breast
cancer, Piaget and THE REGISTRY had came up the
idea of “hand in hand” which became the theme
of the charity photo shoot. With the voluntary
support from the renowned photographer CK
from Secret 9 Production House, a number of
local celebrities were invited to participate in this
meaningful project to help raise the awareness
of hereditary breast cancer. Piaget generously
donated HK$100,000 to support this worthy
cause.
Acknowledgements
Agnes b. DELICES
Bacchus
Belford Jewellery
Bottega Veneta
Boucheron Boutique
Continental Diamond
Dansinn Dance Studio
Dr. Ellen Li Charitable Foundation Ltd.
Dynasty International Group Holdings Ltd.
Emperor Watch and Jewellery (HK) Ltd.
Estēe Lauder Companies
Grand Hyatt Hong Kong
Gucci
Hong Kong Sanatorium and Hospital
Hong Kong Tatler
Hong Kong Yogathon (INT’L) Company Ltd.
Kate Spade
Kerry Group Kuok Foundation
Love * Knots
M.C.L. Design International Ltd.
Moiselle International Holdings Limited
National Institutes of Health
Northern California Cancer Centre
Piaget
PricewaterhouseCoopers
Pringle of Scotland
Rimowa Far East Limited
Salon La Mod
Patron & Advisory Board
Patrons
Lady Helen WOO
The Hon. Mrs. Laura CHA
Mrs. Johanna ARCULLI
Board of Directors
Chairman
Dr. Ava KWONG
Vice Chairman
Dr. TSAO Yen Chow
Apr 2010
Hong Kong Yogathon (Int’l) Co. Ltd. held its third annual
Yogathon 2010 at Happy Valley Racecourse on 11 April.
This was a public event with 100 individuals participated in
an 8-hour yoga relay. Hong Kong Yogathon (Int’l) Co. Ltd
generously donated a total sum of HK$60,000 in support of
the HRBCP.
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 10
Secretary
Dr. CHAN Woon Tong Joseph
Sanofi Aventis Pharmaceuticals
Shangri-la International Hotel Management Ltd.
Shun Hing Group Panasonic
S.T. Dupont
The Joseph Lau Luen Hung Charitable Trust
Thong Sia Watch Co., Ltd. (Seiko)
Times Square Limited
TOUS
Mrs. Johanna Arculli
Mrs. Emily Chan
Dr. & Mrs. Joseph Chan Woon Tong
Ms. Jolie Chan
Mr. Vincent Chan
Ms. Vincy Chan
Ms. Debbie Chang
Ms. Jessica Suen Huen
Mr. Enrico Kwong
Dr. Louis Kwong Junior
Mr. William Louey
Dr. Tony Mok
Mr. Henry Tang Ying-yen, Chief Secretary for Administration
Mr. Siu Kwok Wah
Mr. Simon To
Ms. Bonita Yeung
Ms. Vivian Yeung
Ms. Joey Yung
Treasurer
Dr. SUEN To Ki Dacita
Mr. FUNG Kwok Chor Alfred Dr. HO Leung Sing
Dr. LAW Chun Key Stephen
Dr. WONG Lei Po Chris
Dr. LI Wai Tat Walton
Dr. MA Shiu Kwan Edmond
Dr. WONG TAAM Chi-Woon Vivian
Mr. WONG Tak Wai Alvin
Dr. WONG Ting Ting
Operations Director
Ms. Agatha HU
Honorary International Advisors
Professor James M. FORD, M.D.
Professor Mary-Claire KING, Ph. D.
Professor Olufunmilayo I. OLOPADE, M.D.
Professor Jeffrey WEITZEL, M.D.
Professor Dee W. WEST, Ph.D.
Honorary Advisors
Professor TSUI Lap-Chee
Professor Vivian CHAN
Dr. Michael K.G. MA
Dr. LAW Ka Bo Bonita
Dr. LIM Boon Hua
Dr. Lilian L.Y. LEONG
Fundraising Advisors
Mrs. Beatrice BROWN
Mrs. Christine CHAN
Mrs. Emily CHAN
Mrs. Patti HO
Mrs. Lumen KINOSHITA
Mrs. Stacey MORSE
Miss. Louisa WONG Tak Yu
Friends of HRBCP
Miss. Peggy CHEUNG
Mr. and Mrs. Michael KWAN
Ms. Vikki ONG
Mrs. Lisa TANG
Miss. Sharon YU
Barclays HK Women’s Internal Network
Goldman Sachs
HK Hereditary Breast Cancer Family Registry | Newsletter Issue No. 2 | Page 11
Donor’s Information 捐款者資料
Please fill in this form in BLOCK LETTERS. All data will be treated in strict confidence and for internal use only.
為方便處理,請以英文正楷填寫。所有資料絕對保密,僅供內部使用。
DONATION FORM 捐款表格
(Mr先生/ Dr醫生/ Mrs女士/ Ms小姐/ Miss小姐)Name 姓名 _____________________________________________
Gender 性別 Male 男性/ Female 女性
Company Name (if applicable) 公司名稱 (如適用) _____________________________________________________________________________________________
Address地址 Office辦公室/ Home住宅 ______________________________________________________________________________________________________
Tel 電話 ___________________ Fax 傳真 ___________________
E-mail 電郵 _______________________________
HK ID Card No. 香港身份證號碼 (To avoid donor record duplication 以免捐款人資料重複)
Donor Number 捐款人編號 (For existing donor 現有捐款人)
_____________________________ __________________________
Donation Preference 捐款用途
☑ General Donation 一般用途 ☑ Genetic Epidemiology Research 遺傳流行病研究 ☑ Hong Kong Hereditary and High Risk Breast Cancer Programme
香港遺傳性及高危乳癌普查計劃 (HRBCP)
Donation Methods 捐款方法
One-time donation of 一次性捐款 ☑ HK$300 ☑ HK$500 ☑ HK$1,000
☑ Any amount will help 其他款額 HK$____________________________ ☑ Crossed Cheque No. 支票號碼 ____________________________________________
Payable to “Hong Kong Hereditary Breast Cancer Family Registry”
劃線支票 - 抬頭請寫「香港遺傳性乳癌家族資料庫」。
☑ Direct Transfer 直接存入銀行户口
Please deposit to the Hong Kong Hereditary Breast Cancer Family Registry Account at Wing Lung Bank: 020-611-000-3707-2. To obtain an official receipt, please
send us the original of the bank transfer receipt together with this form to us. 請直接存入「香港遺傳性乳癌家族資料庫」在永隆銀行的戶口,
戶口號碼:020-611-000-3707-2。如需正式收據,請將存款收條正本票同此表格一併寄回。
☑ Credit Card 信用卡 ☑ Visa ☑ MasterCard
Card Holder Name 持卡人姓名 ________________________________
Expiry Date 有效日期__________________________________________ Name on the Receipt 收據上的姓名:_____________________________
Card No 信用卡號碼__________________________________________
Card Holder’s signature 持卡人簽署 _____________________________
Please return the completed form by post or by fax 請將填妥表格寄回以下地址或傳真至 :
Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong Sanatorium & Hospital, 8/F, Li Shu Fan Block, 2 Village Road, Happy Valley, Hong Kong SAR
香港跑馬地山村道二號養和醫院李樹芬院八樓香港遺傳性乳癌家族資料庫
Tel 電話: (852)2835 7028 Fax 傳真: (852)2892 7585
Website網頁: www.asiabreastregistry.com
Email電郵: enquiries@asiabreastregistry.com
Your personal information will be kept strictly confidential. We shall use your information for receipting, educational and fundraising purpose only. Please inform us if you
prefer not to receive future mailings from Hong Kong Hereditary Breast Cancer Family Registry.
閣下的個人資料將會絕對保密,只會用作發行捐款收據、教育及籌款之用途。假如閣下不欲收取香港遺傳性乳癌家族資料庫之通訊,請聯絡我們。
For Office Use Only 銀行專用
Authorization Code 授權密碼 ________________________
* Donations of $100 or above are tax-deductible in Hong Kong HK Hereditary
Breast Cancer Family Registry
Date 日期 _______________ Source Code 密碼 ______________
捐款港幣一百元或以上可作扣除香港稅項之用。
c/o HK Sanatorium & Hospital
8/F, Li Shu Fan Block, 2 Village Road, Happy Valley, Hong Kong SAR
HK Hereditary Breast Cancer Family Registry | Newsletter Issue www.asiabreastregistry.com
No. 2 | Page 12
香港遺傳性乳癌家族資料庫
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