Wira Transplant Malaysia Supporter!!

Yes, I’d like to be a Wira Transplant Malaysia supporter!!
Group Mission:
This is an exclusive group for patients, organ donors, organ recipients, health professionals and transplant supporters living in Malaysia who support organ transplantation.

The objectives of this group

1. To raise awareness on Organ Transplantation amongst Malaysians

2. ⁠To provide financial and moral support to potential Organ donors and recipients

3. ⁠To provide support for Health Professionals in relation to Organ Transplants

4. ⁠To organise events to promote Organ Transplant and encourage healthy lifestyle for Organ donors and recipients

5. ⁠To involve Malaysians, Supporters of Wira Transplant, to create opportunities to participate in Wira Transplant Malaysia activities
Details of Wira Transplant Supporter
Title
Name*

First NameLast Name
Birth Date*

DayMonthYear
Date
Mobile No.*

Country CodeArea CodePhone Number
Email*
example@example.com
Occupation*
T-shirt Size*

XSSMLXL2XL3XL4XL
I am*

DonorOrgan RecipientMedical StaffPatientTransplant Supporter
Facebook Account*
Please type NIL if not available
Instagram Account*
Please type NIL if not available
I would like to contribute a sum of RM*
Minimum RM 110 to be entitled for a T-shirt. Registration: RM10 & Annual Fee: RM100
Please make your payment to

Bank : Public Bank

Name :Persatuan Sokongan Wira Transplant Malaysia

A/C :3240347607

Please mention "WTM", Name and H/P number in the Recipient Details.
Please upload your payment receipt here*

Cancelof
Signature*

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Note:

Corporate Donors who wish to collaborate with us for their CSR programs, please drop us an email to wiratransplant@gmail.com
Should be Empty:

Yes, I’d like to be a Wira Transplant Malaysia supporter!!