Please completed form in BLOCK letter and send us by mail to Senior Citizen Home Safety Association Freepost No. 61 (No stamp required) or by fax at 2304 5193.

• 请以正楷填妥此表格，连同捐款一并寄回长者安居服务协会简便回邮61号(免贴邮票)或传真至23045193。